瑞芬太尼微泵维持下拔除气管导管.DOCVIP

临床医学论文-瑞芬太尼微泵维持下拔除气管导管 【摘要】? 目的 研究瑞芬太尼持续泵注下拔除气管导管对全麻恢复期患者心血管反应及苏醒质量的影响。 方法 89例 ASAⅠ～Ⅱ 级全麻择期手术患者随机分组为瑞芬太尼组(R组，n=30)、丙泊酚组(P组，n=30)和对照组(C组，n=29)。三组患者全麻诱导及麻醉维持方法相同。术毕前20min均停吸异氟醚。15min后，R组静脉微泵减量维持至0.05～0.1μg/(kg·h)，P组继以2mg/(kg·h)维持，两组均于拔管后停用，C组手术结束后即停用瑞芬太尼和丙泊酚。三组均在自主呼吸恢复至潮气量7ml/kg，呼吸频率10次/min，呼末二氧化碳(EtCO2)45%，新斯的明和阿托品静注后拔除气管导管。 结果 R组拔管前后心血管反应轻微，SBP、DBP、MAP、HR与诱导前相比差异无显著性(P0.05)，麻醉恢复期未发生呛咳和无意识躁动;P组和C组上述参数显著升高(分别P0.05和P0.01)。 结论 小剂量瑞芬太尼微泵维持下拔除气管导管，能有效预防全麻围拔管期心血管反应，停药后清醒快并能使整个麻醉苏醒过程安全、舒适、平稳。 【关键词】? 瑞芬太尼;围拔管期;心血管反应 　　【Abstract】 Objective To study the effects of extubation associated with Remifentanil on cardiovascular responses and wake quality in patients in general anesthesia recovery period. Methods Eighty-nine ASA Ⅰ～Ⅱgrade patients were randomly divided into three groups. They received same general anesthesia induction and same maintenance way of anesthesia. They stopped inhalation different oxygen-ether at the same time of surgery. After fifteen minutes, patients in the Remifentanil group (R group, n=30) were given 0.05～0.1μg/(kg·h) intravenous micro-pump, and patients in the Propofol group (P group, n=30) were maintained 2mg/(kg·h) intravenous micro-pump. The intravenous micro-pump of both groups was suspended after extubation. The patients in the control group (C group, n=29) immediately stopped using Remifentanil and Propofol after the surgery. After treatment, all patients in three groups had an extubation surgery. Results There was not significant difference in SBP, DBP, MAP and HR before and after extubation in R group (P0.05) and none of R group occurred choking and unconscious restlessness in anesthesia recovery period. While, SBP, DBP, MAP and HR were all increased in both P group (P0.05) and C group (P0.01). Conclusion Extubation with low-dose Remifentanil through intravenous micro-pump is not only effective in preventing cardiovascular responses, but also can make the whole process of recovery from anesthesia fast, safety, comfort and smooth. 　　【Key words】