摘要
目的评价神经外科手术患者全麻苏醒期应用不同模式瑞芬太尼对患者拔管期呛咳反应的影响。方法ASAI或Ⅱ级择期行颅脑手术的患者60例，均在快速诱导下进行气管插管，术中以微量泵持续输注丙泊酚、瑞芬太尼维持麻醉，术毕按瑞芬太尼的给药方式采用完全随机法分为3组（每组20例）：A组缝皮结束时停止输注瑞芬太尼；B组缝皮结束时停止输注瑞芬太尼，包扎头部时再静脉单次注射瑞芬太尼1μg／kg，C组缝皮结束后继续微泵输注瑞芬太尼0．05μg·kg·min-1至拔管后。记录拔管前、拔管即刻、拔管后1、3min的心率（heartrate，HR）、平均动脉压mean arterial pressure，MAP）、血氧饱和度（oxygen saturation，SpO2），记录手术时间、苏醒时间（丙泊酚停止输注至睁眼时间）、拔管时间（缝皮结束至拔管）、丙泊酚与瑞芬太尼的总用量、呛咳程度、拔管后意识状态等。结果拔管即刻HR：A组（101±7）次／min，B组（904．8）次/min，C组（784．9）次／min；拔管后1min的HR：A组（98±9）次／min，B组（83±6）次／min，C组（80±5）次／min；拔管后3min的HR：A组（93±5）次／min，B组（82±7）次／min，C组（82±5）次／min；B组、C组在拔管后3个时点的HR低于A组，差异有统计学意义（P〈0．05）。拔管即刻MAP：A组（97±11）mmHg（1mmHg=0．133kPa），B组（874．9）mmHg，C组（77±7）mmHg；拔管后1min的MAP：A组（92±8）mmHg，B组（84±8）mmHg，C组（75±6）mmHg；拔管后3min的MAP：A组（854．6）mmHg，B组（804．5）mmHg，C组（76±6）mmHg；B组在拔管即刻、拔管后1min的MAP低于A组，差异有统计学意义（P〈0．05），C组在拔管后3个时点的MAP均低于A组，差异有统计学意义（P〈0．05）。C组拔管后3个时点的HR、MAP与拔管前比较差异无统计学意义（伶0．05）。A、B、C3组苏醒时间、拔管时间、拔管后OAA／S评分差异无统计学意义（P〉0．05）；拔管期A组均出现呛咳，8例轻度、12例中度，B组13例无呛咳、7例轻度呛咳，C组16例无呛咳、4例轻度呛咳，与A组比较，B组、C组呛咳的发生率及程度均降低（P〈0．05）。结论手术结束时继续持续输注0．05μg·kg-1·min。的瑞芬太尼或单次静脉注射瑞芬太尼1μg/kg可提高患者的耐管性，减少呛咳反应，抑制拔管期间HR、MAP的过度变化，且不影响患者苏醒时间。
Objective To evaluate the effect of different applications of remifentanil on cough response during emergence from general anesthesia in patients undergoing neurological procedures. Methods Sixty patients scheduled for neurological procedures （ASA I - II ） were performed the tracheal intubation by the way of fast induction, anesthesia was maintained with continuous infusion of propofol combined with remifentanil during the operation. At the end of operation, all patients were randomly assigned into three groups （n=20） by different applications of remifentanil： group A, B, C. Patients in group A were not infused remifentamil until incision was closed. Remifentanil infusion was stopped when the incision was totally closed, group B recived a bolus dose of remifentanil （1 μg/kg） again at bandaging the incision. Group C received the continuous infusion of remifentanil 0.05 μg·kg-1·min-1 until extubation, heart rate （HR）, mean arterial pressure （MAP） and oxygen saturation （SpO2）, were recorded before extubation, extubation immediately, 1 and 3 min after extubation, respectively. Operating time, recovery time, extubating time, the total consumption of propofol and remifentanil, and the degree of cough response were also observed. Results At the time point of extubation, HR was （101±7）, （90±8） and （78±9） beats/min in group A, B and C, respectively, at 1 min after extubation, HR was （98±9）, （83±6） and （80±5） beats/min in group A, B and C, respectively; at 3 min after extubation, HR was （93±5）, （82±7） and （82±5） beats/min in group A, B, and C, respectively. HR was significantly lower in group B and C than in group A at all the time points（P〈O.05 ）. At the time of extubation, MAP was （97±11）, （87±9） and （77±7） mm Hg（ 1 mm Hg =0.133 kPa） in groupA, B and C, respectively, at 1 min after extubation, MAP was （92±8）, （84±8） and （75±6） mm Hg in group A, B and C, respectively; at 3 rain after extubation, MAP was （85±6）, （80±5） and （76±6） mm Hg in group A, B and C, respectively. Compared with group A, MAP siginificantly decreased at time of extubation and 1 minute after extubation in group B, also siginifieantly decreased at three recorded time in group C （P〈0.05）. HR and MAP at all recorded time after extubation had no significant difference compared with the time point before extubation in group C （P〉O.05）. There was no significant difference in awake time, extubating time and OAA/S scores after extubation among three groups （P〉0.05）. During extubation, there were 8 patients with slight cough and 12 patients with heavy cough in group A, 7 patients slightly coughed and 13 patients with no cough in group B, only 4 patients slightly coughed in group C. The incidence and degree of cough were significantly lower in group B and C than in group A （P〈0.05）. Conclusions Continuous infusion of remifentanil （0.05 μg·kg-1·min-1） until extubation or a bolus of remifentanil （1 μg/kg） may elevate patient＇s toleration of irltubation, reduce their cough response, and inhibit their over-change of HR and MAP during extubation without affecting the recovery from anesthesia.
出处
《国际麻醉学与复苏杂志》
CAS
2012年第2期87-90,共4页
International Journal of Anesthesiology and Resuscitation
关键词
哌啶类
麻醉
全身
拔管术
神经外科手术
Piper dines
The general anesthesia
Extubation
Neurosurgical procedures
