国际麻醉学与复苏杂志   2013, Issue (2): 4-4
    
全麻苏醒期持续静脉靶控输注瑞芬太尼对气管拔管时的影响
徐四七, 王胜斌, 居霞, 肖敬波, 胡胜红, 李元海1()
1.安徽医科大学附属安庆市立医院
Effects of target controlled infusion of remifentanil during emergence on the recovery profiles of tracheal extubation from anaesthesia
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摘要:

目的 观察全麻苏醒期维持静脉靶控输注瑞芬太尼(remifentanil, RF)对甲状腺手术患者血流动力学及呛咳发生率的影响。 方法 甲状腺手术患者80例,年龄20岁~58岁,男41例,女39例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,按随机数字表法分为4组,每组20例,麻醉方法采用气管内静脉全麻,术中采用RF血浆靶控浓度维持4 μg/L~6 μg/L,丙泊酚血浆靶控浓度2.8 mg/L维持麻醉,手术结束缝皮时停止输注丙泊酚。调整血浆RF靶浓度分别为0(RF0.0组)、1.5(RF1.5组)、2.0 μg/L (RF2.0组)和2.5 μg/L组(RF2.5组)持续输注直至拔管后停止。评价血流动力学变化及呛咳的发生率和严重性。 结果 RF2.0组和RF2.5组拔管时呛咳的发生率和严重性明显低于RF0.0组(P<0.05)。与RF0.0组拔管即刻和拔管后1 min平均动脉压(MAP)[(100±5)、(105±4) mm Hg(1 mm Hg=0.133 kPa)]和心率(HR)[(104.9±5.1)、(118±5) 次/min]比较,RF各组拔管即刻MAP[(95±4)、(87±4)、(82±4) mm Hg]、HR[(96.1±3.4)、(85.2±3.0)、(79.9±2.4) 次/min]和拔管后1 min MAP[(100±3)、(90±4)、 (86±4) mm Hg]、HR[(103±3)、(92±3)、(84±3) 次/min]明显降低,差异均有统计学意义(P<0.05),RF2.5组拔管即刻和拔管后 1 min MAP[(82.4±4.3)、(85.7±4.0) mm Hg]和HR[(79.9±2.4)、(84.4±3.3) 次/min]明显低于RF1.5组MAP[(95±4)、(100±3) mm Hg]、HR[(96.1±3.4)、(103±3) 次/min]和RF2.0组MAP[(87±4)、(90±4) mm Hg]、HR[(85.2±3.0)、(92±3) 次/min],差异均有统计学意义(P<0.05)。与RF0.0组睁眼时间和拔管时间[(8.0±0.6)、(9.8±0.5) min]比较,RF1.5组[(8.0±0.3)、(9.9±0.5) min]和RF2.0组[(8.2±0.3)、(10.1±0.4) min]差异无统计学意义,但RF2.5组[(8.3±0.5)、(11.6±0.7) min]明显延迟,差异均有统计学意义(P<0.05)。 结论 RF持续靶控输注可明显降低气管拔管相关血流动力学变化及呛咳反应,但随RF剂量增加,麻醉苏醒时间延迟。

关键词: 瑞芬太尼;靶控输注; 气管拔管;全凭静脉麻醉
Abstract:

Objective The trial was designed to examine the effects of target controlled infusion of remifentanil on recovery profiles such as cardiovascular responses and coughing after anaesthesia for thyroidectomy. Methods Eighty ASA Ⅰor Ⅱ patients undergoing thyroidectomy surgery were randomly assigned to RF0.0 group, RF1.5 group, RF2.0 group, RF2.5 group. Each group contained 20 subjects. General anesthesia was maintained by total intravenous anesthesia (propofol and remifentanil). The target plasma concentrations of remifentanil were 0(RF0.0 group), 1.5(RF1.5 group), 2.0 (RF2.0 group), and 2.5 μg/L (RF2.5 group) during emergence from anesthesia. At the end of surgery, propofol was ceased. The infusion of remifentanil was stopped in RF0.0 group while maintained in the other 3 groups at a target plasma concentration of 1.5, 2.0 μg/L or 2.5 μg/L till extubation. Heart rate (HR), mean arterial pressure (MAP), incidence and severity of coughing were recorded. Results The incidence and severity of coughing were lower in RF2.5 group and RF2.0 group compared with RF0.0 group(P<0.05). MAP[(95±4), (87±4) mm Hg and(82±4) mm Hg(1 mm Hg=0.133 kPa)]and HR[(96.1±3.4), (85.2±3.0) and (79.9±2.4) bpm] values were significantly lower in the 3 groups rather than in RF0.0 group [MAP, (100±5) mm Hg and HR, (105±4) bpm] at the moment of tracheal extubation(P<0.05). MAP [(100±3), (90±4) mm Hg and (86±4) mm Hg] and HR [(103±3),(92±3) bpm and (84±3) bpm] values were significantly lower in the 3 groups compared with the RF0.0 group [(100±5) mm Hg and(105±4) mm Hg] at 1 min after tracheal extubation(P<0.05). MAP [(82.4±4.3) mm Hg and (85.7±4.0) mm Hg ] and HR [(79.9±2.4) bpm and (84.4±3.3) bpm] values were significantly lower in RF2.5 group compared with RF1.5 group[(95±4) mm Hg and (100±3) mm Hg][(96.1±3.4) bpm and (103±3) bpm] or RF2.0 group [(87±4) mm Hg and (90±4) mm Hg ] [(85.2±3.0) bpm and (92±3) bpm] at the moment or 1 min after tracheal extubation(P<0.05). But time to eye opening and extubation were prolonged in RF2.5 group [(8.3±0.5) min and (11.6±0.7) min] compared with the RF0.0 group[(8.0±0.6) min and (9.8±0.5) min](P<0.05). Conclusions Maintaining a remifentanil plasma concentration by TCI may reduce haemodynamic changes and incidence of coughing which associated with tracheal extubation in patients undergoing thyroidectomy. However, awakening may be delayed due to the relative higher remifentanil dose.

Key words: Remifentanil; Target-controlled infusion; Tracheal extubation; Total intravenous anesthesia