靶控输注雷米芬太尼预防全麻苏醒拔管期应激反应的观察及护理.pdfVIP

现代临床护理(Modem Clinical Nursing)2008．7(I) 19 靶控输注雷米芬太尼预防全麻苏醒拔管期应激反应 的观察及护理 朱琼芳，陈旭素，李 芳，张翠梅，黄毓婵，罗文颖 (中山大学附属第一医院麻醉科恢复室，广东广州，510080) [摘要] 目的 观察雷米芬太尼靶控输注对全麻苏醒拔管期应激反应的影响及护理。方法 择期行妇科手术患 者6O例，ASA I～Ⅱ级，随机分为雷米芬太尼组(A组，3O例)和对照组(B组，3O例)。两组患者均接受丙 白酚、维库溴铵、 芬太尼、0．8％～3．O％异氟醚的全身麻醉。术毕时送至麻醉复苏室，A组患者靶控输注雷米芬太尼，血浆浓度为I I~g／L，B 组靶控输注生理盐水作对照。观察苏醒期患者的平均动脉压、心率、呼吸恢复时间、睁眼时间和拔管时间。结果 A组患 者在吸痰、拔管时平均动脉压、心率无明显变化，患者躁动少，需用镇痛和镇静药处理患者少，B组则明显升高(PO．05)； 两组患者呼吸恢复、睁眼、拔管时间差异无统计学意义(均PO．05)。结论 靶控输注雷米芬太尼可抑制全麻苏醒拔管 期的虚激反应，平稳苏醒，明显减轻护理工作量。 [关键词] 雷米芬太尼；气管拔管；应激反应；护理 [中图分类号] R473，6 [文献标识码] A [文章编号] 167I-8283(2008)Ol一0019—03 [Abstract] 0bjective To observe the effect of remifentanil given by target—controlled infusion(TCI) on the stress response caused by tracheal extubation and to explore the nul’sing strategies． Methods Sixty ASA I～I／female patients undergoing gynecological surgely were randomly dix ided into two groups：group A(n=30) and group B(n=30)．All patients received a standard general anesthesia comprising propofol，vecuronium，fentanil，O．8％ 一3．O％ isoflunence with 50％ nitrousoxide in ox)rgen．At the end of surgery，remffentanil was given by TCI at a fixed plasma concentration of I I~g／L in group A．Saline placebo was given by TCI in group B．Mean arterial pressure(MAP)，heart late(HR)，recovery time of breath，opening eye and tracheal extubation were recorded respectively． Results Remifentanil attenuated the increase in both MAP and HR at sputum aspiration and extubafion． There was no significant difference in the recovery time of breath， opening eye and tracheal extubafion． Conclusion Remifentanil given by TCI inhibits the stress reaction during the palinesthesia extubation period and significantly reduce the nursing workload． [Key words]remifentanil；tracheal extubation；stress reaction；nursing 全身麻醉是临床上常用的麻醉方法，全麻术