摘要
目的观察瑞芬太尼持续输注对外耳再造手术小儿全身麻醉拔管的循环反应以及拔管相关不良反应的影响。方法选取美国麻醉医师协会分级Ⅰ~Ⅱ级择期全身麻醉拟行自体肋软骨移植外耳再造手术患儿60例,按随机数字法分为对照组和瑞芬太尼组,每组30例。两组患儿的麻醉诱导均采用舒芬太尼+丙泊酚+罗库溴铵方案,麻醉维持采用瑞芬太尼+丙泊酚+60%N_2O方案。两组均术毕前5 min停用吸入和静脉麻醉药物,瑞芬太尼组将瑞芬太尼浓度减至0.05μg/(kg·min)持续输注直至拔出气管导管,对照组停瑞芬太尼输注。观察两组小儿麻醉诱导前(T0)、手术结束时(T1)、拔管前即刻(T2)、拔管后1 min(T3)、拔管后3 min(T4)、拔管后5 min(T5)的平均动脉压(MAP)、心率和脉搏血氧饱和度(SpO_2);记录自主呼吸恢复时间、苏醒时间、拔管时间;记录拔管时患儿呛咳反应状况,拔管后5 min内是否发生呼吸抑制及恶心呕吐。结果两组患儿T1_时间点MAP、心率出现明显降低,T_2、T_3时间点的MAP、心率出现明显升高;T_4、T_5时间点MAP、心率出现降低,与T_0时间点接近。对照组T_2、T_3的MAP明显高于T_0(P<0.05);瑞芬太尼组除T_5外其余各时点MAP均明显低于T_0(P<0.05)。对照组和瑞芬太尼组T_2、T_3的心率均较T_0明显加快,瑞芬太尼组T_2、T_3的MAP、心率较对照组明显下降(P<0.05)。对照组和瑞芬太尼组各时点的SpO_2均无明显变化(P>0.05)。瑞芬太尼组的拔管呛咳反应评分显著低于对照组[(1.33±0.60)分比(2.03±0.90)分,P<0.05]。两组患儿的自主呼吸恢复时间、苏醒时间、拔管时间、清醒镇静评分、呼吸抑制及恶心呕吐发生率差异无统计学意义(P>0.05)。结论小儿全身麻醉拔管期持续静脉输注瑞芬太尼0.05μg/(kg·min),可以明显减轻拔管期间的心血管反应和拔管时的呛咳反应,且不延长麻醉恢复时间。
Objective To observe the effect of remifentanil infusion on circulatory response and extubation-related adverse effects to the children undergoing ear reconstruction surgery with general anesthesia in tracheal extubation period.Methods A total of 60 cases withⅠ-Ⅱof ASA assessment rating,who would undergo elective ear reconstruction surgery with autologous rib cartilage were randomly divided into a remifentanil group and a control group,30 cases each.Both groups were induced by anesthesia sufentanil+propofol+rocuronium and maintained by anesthesia remifentanil+propofol+60%N 2O.Inhalation and intravenous anesthetics were discontinued 5 minutes before the end of the surgery.The patients in the remifentanil group were continuously injected remifentanil[0.05μg/(kg·min]from the end of the surgery to extubation.The patients in the control group were not injected remifentanil from the end of the surgery to extubation.The spontaneous breathing recovery time,awaking time,extubation time,and the mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO 2)at the time points of before induction of anesthesia(T 0),the end of the surgery(T 1),extubation(T 2),1 minute after extubation(T 3),3 minutes after extubation(T 4),5 minutes after extubation(T 4)were recorded respectively.The responses to extubation,respiratory inhibition,nausea and vomiting in 5 min after extubation were recorded.Results MAP,HR of the two groups were significantly decreased at T 1,increased at T 2 and T 3;while significantly decreased at T 4 and T 5,approaching to the level at T 1(P<0.05).MAP at T 2 and T 3 were significantly higher than MAP at T 0 in the control group(P<0.05).MAP at all the time points except T 5 were significantly lower than MAP at T 0 in the remifentanil group(P<0.05).HR at T 2 and T 3 were significantly higher than HR at T 0 in both groups(P<0.05).MAP,HR at T 2 and T 3 in the remifentanil group were significantly lower than those in the control group(P<0.05).SpO 2 of the cases at the different time points had no significant differences in the remifentanil group and the control group(P>0.05).The incidence of the response to extubation in the remifentanil group were significantly lower than that in the control group[(1.33±0.60)scores vs(2.03±0.90)scores,P<0.05].There were no significant differences in spontaneous brea-thing recovery time,awaking time,extubation time and observer′s assessment of alertness/sedation scale of the two groups(P>0.05).The incidence of the respiratory inhibition,nausea and vomiting of the two groups had no statistically significant differences(P>0.05).Conclusion By continuous injection of remifentanil[0.05μg/(kg·min)]on pediatric patients with general anesthesia in tracheal extubation period,it can significantly reduce the risk of cardiovascular reaction and the cough response,without prolonging anesthesia recovery time.
作者
相贵华
邓晓明
杨冬
孙晓乐
徐瑾
陈春梅
刘具会
王磊
陈柯宇
邵飞
XIANG Guihua;DENG Xiaoming;YANG Dong;SUN Xiaole;XU Jin;CHEN Chunmei;LIU Juhui;WANG Lei;CHEN Keyu;SHAO Fei(Department of Anesthesiology,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)
出处
《医学综述》
2018年第6期1244-1248,共5页
Medical Recapitulate
关键词
瑞芬太尼
持续输注
小儿
全身麻醉
Remifentanil
Continuous injection
Children
General anesthesia
