摘要
目的观察输注瑞芬太尼对七氟烷吸入全身麻醉患者术后苏醒期恢复质量的影响。方法选择国家癌症中心／中国医学科学院北京协和医学院肿瘤医院2016年2至8月择期全身麻醉下行胸腔镜肺叶切除手术、美国麻醉医师协会（ASA）I-Ⅱ级、年龄37～65岁患者100例，采用随机数字表法将其分为：七氟烷（S组）和七氟烷＋瑞芬太尼组（SR组），每组50例患者。所有患者常规静脉诱导气管插管后，间断静脉注射舒芬太尼，S组患者：吸入2％七氟烷，SR组患者：吸入1．5％七氟烷、持续静脉输注瑞芬太尼（4μg·-·h-1）维持麻醉。测量比较患者术中血液动力学指标。记录所有患者清醒和气管拔管的时间，统计患者恢复期严重咳嗽和躁动发生率。统计患者恢复室内严重疼痛、恶心呕吐的发生率。结果SR组患者气管拔管时的血压和心率显著低于S组，差异均有统计学意义（均P〈0．05）。sR组清醒时间为（4．2±2．1）min，气管拔管时间为（4．8±3．1）min，显著短于S组的（12．7±3．4）min和（15．4±4．1）min，差异均有统计学意义（t=-15．040、-14．582，均P〈0．05）。S组患者躁动和严重咳嗽发生率分别为48％和58％，显著高于SR组的6％和10％，差异均有统计学意义（χ2=20．294、23．574，均P〈0．05）。两组患者恢复室内镇痛数字评分（NRS）和自述尿管相关膀胱不适症状发生率差异均无统计学意义（均P〉0．05）。结论七氟烷全身麻醉患者联合输注瑞芬太尼可缩短清醒时间和气管拔管时间，降低苏醒期严重呛咳、躁动发生率，明显改善患者苏醒期恢复质量。
Objective To investigate the effects of remifentanil infusion on emergence and recovery characteristics of patients with thoracoscopic lobectomy following general anaesthesia with sevoflurane. Methods One hundred patients,who were aged 37 to 65 years with American Society of Anesthesiologists （ASA） physical status 1 -2,and scheduled for elective thoracoscopic lobectomy under general anaesthesia in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,from February 2016 to August 2016, were allocated to receive sevoflurane maintenance regimen （ group S, n = 50 ） or sevoflurane/remifentanil maintenance regimen （ group SR, n = 50 ） by random digital table. After routine induction and intubation, anaesthesia was maintained with 2% sevoflurane in group S and 1.5% sevoflurane/remifentanil （ continuous intravenous injection at rate of 4 μg · kg-1 · h-1） coadministration in group SR respectively, with intermittent intravenous infusion of sulfentanil. Haemodynamic variables were collected at different time points and compared between two groups. Awaking time and extubation time, incidences of serious coughing and agitation were evaluated during emergence. Postoperative pain, nausea and eather-related bladder discomfort （CRBD） were evaluated in post anesthesia care unit. Results Compared with group S, the arterial blood pressure and heart rate were significantly lower in group SR at extubation（ all P 〈 0. 05 ）. Time to awaking and to extubation in group SR were （4. 2 ± 2. 1 ） min and （4. 8± 3.1 ） min respectively, in group S were （ 12. 7 ± 3.4 ） min and （ 15.4 ± 4. 1 ） min. The difference between two groups were statistically significant （ t = - 15. 040, 14. 582, all P 〈 0. 05 ）. The incidences of serious coughing and agitation in group S were 48% and 58% ,which were greater than those of group SR（6% and 10% ）. The difference were statistically significant（χ2 = 20. 294,23. 574, all P 〈 0.05 ）. The NRS and incidence of complaining CRBD were similar in both groups （ all P 〉 0.05 ）. Conclusion Compared with sevoflurane maintenenee, coadministration of remifentanil and sevoflurane maintenance regimen provides better emergence and recovery which are characterized by faster awakening and extubation with a lower incidence of emergence coughing and agitation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第44期3450-3454,共5页
National Medical Journal of China
关键词
麻醉
全身
恢复期
七氟烷
瑞芬太尼
Anesthesia, general
Convalescence
Sevoflurane
Remifentanil
