【摘要】 目的比较靶控输注瑞芬太尼与单次静脉给予右美托咪啶对全麻患者的复苏质量。方法择期全麻下行甲状腺手术患者60例,ASA分级Ⅰ或Ⅱ级,随机分为两组(n=30):瑞芬太尼(R)组和右美托咪啶(D)组。麻醉诱导以咪达唑仑0.05mg/kg、丙泊酚2mg/kg静注,瑞芬太尼效应室浓度为2ng/ml TCI,待患者意识消失后给予0.15mg/kg顺式阿曲库铵后插入加强钢丝气管导管,接呼吸机控制呼吸。麻醉维持以2ng/ml瑞芬太尼TCI和吸入七氟醚。R组瑞芬太尼持续输注到拔管,D组手术结束前10min停止输注瑞芬太尼改为右美托咪啶0.5μg/kg。记录手术结束前5min(T0),手术结束即刻(T1),拔管后1min(T2)、3min(T3)、5min(T4)平均血压(MAP)和心率(HR);记录麻醉复苏期自主呼吸恢复时间、咳嗽反应、拔管时间。记录PACU停留时间,高血压、低血压、心动过缓、术后痛、寒颤和恶心呕吐等麻醉恢复期不良事件的发生情况。结果患者年龄、体重、手术时间、ASA分级组间比较差异无统计学意义(P>0.05)。两组患者比较:T0、T1时点D组MAP升高,T4时点D组MAP降低(P<0.05);T3、T4时点D组HR降低(P<0.05);D组患者自主呼吸恢复时间缩短,麻醉恢复期咳嗽增多(P<0.05);R组患者麻醉恢复期高血压、疼痛、恶心呕吐增多(P<0.05)。结论靶控持续输注瑞芬太尼减轻全麻复苏期咳嗽反应较单次静注右美托咪定有效,但右美托咪啶复苏期呼吸循环更平稳。更多还原

【Abstract】 Objective To compare the recovery quality of general anesthesia in patients with remifentanil target controlled infusion(TCI) and single dose dexmedetomidine. Methods Sixty patients subjected general anesthesia were randomly divided into two groups(n=30): remifentanil group(R),dexmedetomidine group(D). Anesthesia was induced with midazolam 0.05mg/kg,propofol 2mg/kg,remifentanil TCI with the effect compartment concentration of 2ng/ml. Treated with 0.15mg/kg of cisatracurium after patients lost consciousness then inserted reinforcing steel tracheal catheter and controlled ventilator respiratory. Anesthesia maintained with remifentanil TCI which the effect compartment concentration was 2ng/ml and sevoflurane inhalation. Remifentanil TCI to extubation in R group. In D group,stopped remifentanil TCI before 10min at the end of operation and infuse a single-dose dexmedetomidine with 0.5μg/kg. Recorded the mean blood pressure(MAP) and heart rate(HR) 5min before the end of operation(T0),at the end of operation(T1),1min(T2),3min(T3) and 5min(T4) after extubation. Recorded the time of spontaneous breathing recovery, cough response, extubation time,the PACU residence time,hypertension,hypotension,bradycardia,postoperative pain,shivering,nausea and vomiting during anesthesia recovery period. Results There was no significant difference with age,weight,operation time,ASA grade between the two groups(P>0.05). Compared with group R:the MAP increased at T0,T1 time point and decreased at T4 time point in group D(P<0.05). The HR decreased at T3,T4 time point in group D(P<0.05). Spontaneous breathing recovery time was shorter in group D than that in group R(P<0.05). The cough increased in group D at recovery period(P<0.05). The hypertension,pain,nausea and vomiting increased in group R at recovery period(P<0.05). Conclusion Remifentanil target controlled infusion reduce cough response from genal anesthesiamore effectively than single-dose dexmedetomidine. However, a single-dose dexmedetomidine has the effect with respect to respiratory and hemodynamic stability during recovery period.更多还原