【作者】 王群；

【导师】 高淑文； 傅志俭；

【作者基本信息】 山东大学 ， 麻醉学， 2007， 硕士

【摘要】 目的：观察全麻术后患者气管拔管期间应用瑞芬太尼后收缩压、舒张压、心率以及血糖、乳酸和皮质醇浓度的变化，来评价瑞芬太尼抑制气管拔管反应的效果，并探寻国人应用的最佳剂量。方法：60例气管插管全麻手术患者，随机分为5组（n=12），对照组（Ⅰ组），瑞芬太尼0.25μg·kg^-1组（Ⅱ组），瑞芬太尼0.5μg·kg^-1组（Ⅲ组），瑞芬太尼0.75μg·kg^-1组（Ⅳ组），艾司洛尔1.5mg·kg^-1（Ⅴ组）。各组药物均用生理盐水稀释至10mL，于气管拔管前静脉推注，时间大于30s，记录拔管前、拔管即刻、拔管后2min、5min、10min的血流动力学（SBP、DBP、HR）数值，并在以上5个时点经锁骨下静脉采集静脉血3mL，测血糖（Glu）、乳酸（Lac）和皮质醇（Cor）浓度，并经桡动脉抽血做血气分析，同时记录嗜睡、呼吸抑制等副作用的发生。结果：与拔管前比较，Ⅰ组患者拔管即刻、拔管后2minSBP、DBP、HR升高（P＜0.05），拔管后5min恢复至拔管前水平；Ⅱ组拔管即刻、拔管后各时点SBP、DBP略有升高但无统计学意义，HR增快明显（P＜0.05）；Ⅲ组拔管即刻、拔管后2minSBP、DBP明显下降（P＜0.01），拔管后5min逐渐恢复，HR拔管后各时点均低于拔管前（P＜0.01）；Ⅳ组拔管即刻及以后各时点SBP均明显下降（P＜0.01），拔管即刻DBP下降，直至拔管后5min（P＜0.05），拔管即刻及拔管后2minHR下降（P＜0.05）；Ⅴ组拔管即刻SBP、DBP、HR下降（P＜0.05）。与Ⅰ组比较，Ⅱ组各时点SBP、DBP、HR无差异（P＞0.05），Ⅲ、Ⅳ、Ⅴ组拔管即刻及拔管后2min的SBP、DBP、HR明显降低（P＜0.05），5min后无差异；与Ⅱ组比较，Ⅲ、Ⅳ、Ⅴ组拔管即刻的SBP、DBP、HR明显降低（P＜0.05），而拔管后2minⅢ组DBP和Ⅳ、Ⅴ组SBP、DBP仍较低（P＜0.05），5min后均无差异。各组患者拔管后的Glu浓度均比拔管前有所升高（P＜0.05）；与Ⅰ组比较，Ⅲ组患者拔管即刻Glu升高的幅度明显减小（P＜0.01）。与拔管前比较，Ⅰ组患者拔管后Cor浓度升高明显；与Ⅰ组比较，Ⅱ、Ⅲ、Ⅳ、Ⅴ组拔管即刻Cor升高的幅度明显减小（P＜0.01）。拔管即刻各组Lac浓度均有所升高，拔除导管后，呼吸自如或给予100％纯氧吸入后逐渐降至拔管前水平，Lac的变化各组之间差异无统计学意义。在副作用方面，Ⅰ组患者发生呛咳4例，发生率明显高于各瑞芬太尼组，与艾司洛尔组相似（3例），Ⅳ组发生嗜睡6例、呼吸抑制4例、心动过缓2例，明显高于其他组（P＜0.05）。结论：本研究结果提示，全麻术后患者气管拔管前静脉注射不同剂量(0.5μg·kg^-1、0.75μg·kg^-1)瑞芬太尼能有效抑制气管拔管反应；总体效果优于艾司洛尔；瑞芬太尼0.5μg·kg^-1的剂量效果最好。更多还原

【Abstract】 Objective:To observe the effects of remifentanil on SBP, DBP, HR, glucose, lactate and cortisol at extubation after general anaesthetic patients, evaluate the result of remifentanil on tracheal extubation and search for a suitable dosage for domestic people.Methods:Sixty ASA I -II patients undergoing elective operation under general anesthesia were randomly divided into 5 groups with twelve patients in each group. Group I received 0.9% sodium chloride injection 10mL iv, group II remifentanil 0.25μg·kg^-1 iv, group III remifentanil 0.5μg·kg^-1 iv, group IV remifentanil 0.75μg·kg^-1 iv, and group V esmolol 1.5mg·kg^-1 iv. All test drugs were injected intravenously more than 30s. The blood sample were taken before extubation, at the time of extubation and 2, 5, 10min after extubation for determination of plasma cortisol, lactate and glucose, recorded the changes of hemodynamics and incidence of side effects such as lethargy and respiratory depression.Results:The patients of five groups were comparable with respect to age, gender, body weight, SBP, DBP, HR, SpO₂, type of operation and duration of operation. Compared with before extubation, SBP, DBP and HR increased significantly at the time of extubation and 2min after extubation（P<0.01）, recovered after 5min in group I . SBP and DBP showed no significant increase but HR increased significantly in group II （P<0.01）. There were significant decrease of SBP and DBP at extubation and 2min after extubation（P<0.01）, recovered after 5min, but HR was low during extubation period in group III. SBP showed significant decrease during extubation period, DBP decreased at the time of extubation and recovered after 5min, HR decreased at extubation and 2min after extubation in group IV. SBP, DBP and HR all decreased at extubation in group V（P<0.05）. Compared with group I , there were no difference in SBP, DBP and HR during extubation in group II （P>0.05）, there were significant decreases of SBP, DBP and HR in group III, IV and V （P<0.05）. Compared with group II, SBP, DBP and HR decreased significantly at the time of extubation in group III IV and V （P<0.05）, DBP showed differences in group III and SBP showed differences in group IV and V at 2min after extubation. There were significant increase in glucose at extubation and 2, 5, 10min after extubation in each group. Compared with group I and II, the increment of glucose in group III was significantly small at extubation（P<0.05）. Cortisol increased significantly after extubation in group I , but increased less in other groups and showed significant difference compared with group I . Lactate increased slightly at extubation, but recovered after breath in 100% oxygen, there was no significant difference in five groups. Four patients with bucking occurred in group I , significantly higher than those of group III and IV （P<0.05）, but similar to group V （three patients）. Six patients with lethargy and four patients with respiratory depression occurred in group IV.Conclusion:Iv. inject different doses of remifentanil(0.5μg·kg^-1, 0.75μg·kg^-1)before extubation can attenuate the increase of hemodynamics, glucose, lactate and cortisol at tracheal extubation, the result is more efficient than esmolol and 0.5μg·kg^-1 is perfect.更多还原