小剂量瑞芬太尼预防全麻气管拔管时心血管反应.docVIP

小剂量瑞芬太尼预防全麻气管拔管时心血管反应 　 作者：郑敏, 杨镭镭, 田刚, 王清秀 　[摘 要] 目的：观察拔管前小剂量瑞芬太尼对预防全麻气管拔管反应的临床效果。方法：选择40例ASA分级Ⅰ、Ⅱ级的择期非心脏手术的全麻患者，随机分为对照组（C组）和瑞芬太尼组（R组），每组20例。二组患者麻醉的诱导和维持方式相同。麻醉维持采用吸入异氟醚，静脉微量泵持续泵注瑞芬太尼0.1~0.4 μg#12539;kg-1#12539;min-1,术毕C组停用瑞芬太尼，R组持续泵注0.1 μg#12539;kg-1#12539;min-1瑞芬太尼。分别记录三组患者拔管前、拔管时、拔管后1 min、3 min、5 min等各时段的收缩压、舒张压、心率和拔管后1 min,3 min,5 min潮气量、呼吸频率、血氧饱和度的变化。结果：C组拔管前后血压和心率相比差异有显著性（Plt;0.05），R组拔管前后血压和心率无显著性差异(Pgt;0.05)。在拔管时及拔管后1 min、3 min、5 min等时段R组SBP、DBP、HR变化与C组比较下降明显，差异有显著性（Plt;0.05或Plt;0.01）。拔管后两组患者VT、RR、Sp02均无显著性差异（Pgt;0.05）。结论：拔管前小剂量静脉泵入瑞芬太尼能有效减轻拔管时的反应。　　[关键词] 瑞芬太尼;气管拔管;心血管反应 　　Abstract:Objective To observe the effect of low dose remifentanil on cardiovascular response to tracheal extubation of patients. Methods Forty ASA Ⅰ-Ⅱpatients scheduled for un-cardiosurgery under general anesthesia were randomly divided into two groups:control group and remifentanil group. Anesthesia was induced with same method,maintained with inhalation of isoflurane and a continuous infusion of remifentanil (0.1~0.4 μg#12539;kg-1#12539;min-1).Continuous infusion of remifentanil(0.1 μg#12539;kg-1 #12539;min-1) was only in remifentanil group until extubation. The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR) were recorded before extubation, at extubation, 1 min,3 min and 5 min after extubation. Tidal volume（VT）,respiratory rate（RR）,pulse oxygen saturation(SpO2) were also observed at 1 min,3min and 5 min after extubation. Results HR,SBP and DBP in control group were much higher than the basic value(Plt;0.05). There were significant difference between control group and remifentanil group(Plt;0.05, Plt;0.01) at extubation,1 min,3 min after extubation. But VT,PR,SpO2 in two groups have no significant difference after extubation(Pgt;0.05). Conclusion Continuous infusion of remifentanil may offer superior hemodynamic stability to extubation without compromising recovery from anesthesia. 　　 　　Key words: Remifentanil;Extubation;Cardiovascular response 　　全麻后气管拔管时可引起血压剧增