靶控输注瑞芬太尼对全麻苏醒期心血管反应的影响

目的:观察靶控输注瑞芬太尼对全麻患者苏醒期心血管反应的影响。方法:选择ASAⅠ~Ⅱ级,择期腰椎手术患者60例,随机分为瑞芬太尼组(R组)和对照组(C组)各30例,R组手术结束后持续靶控输注瑞芬太尼(4 ng/ml)直至气管拔管时停药;C组手术结束时即停止输注瑞芬太尼。观察2组患者麻醉前(T₁)、拔管时(T₂)、拔管后1 min(T₃)、拔管后3 min(T₄)及拔管后5 min(T₅)的血压、心率,记录患者自主呼吸恢复时间、拔管时间、躁动呛咳等心血管不良事件的发生及拔管后不良记忆的患者例数。结果:与R组比较,C组T₂、T₃、T₄、T₅时间点血压均明显升高,心率均显著增快(P<0.01);2组患者呼吸恢复及拔管时间差异均无统计学意义(P>0.05),苏醒时躁动呛咳等心血管不良事件中C组明显增加(P<0.01),拔管后有不良记忆例数C组明显多于R组(P<0.01)。结论:瑞芬太尼4 ng/ml靶控输注能安全有效地减轻全麻患者苏醒期心血管反应,有利于血流动力学稳定,提高患者舒适度。

The effect of the target-controlled infusion of remifentanil on the cardiovascular reaction during general anesthesia recovery period

Objective:To explore the effects of the target-controlled infusion(TCI) of remifentanil on the cardiovascular reaction during general anesthesia recovery period. Methods:Sixty ASAⅠ-Ⅱ patients scheduled by lumber operation were randomly divided into the remifentanil group(group R,30 cases) and control group(group C,30 cases). The 4 ng/ml of remifentanil was continuously injected into the group R by TCI from the end of operation to the tracheal extubation,the injection of remifentanil in group C stopped at the end of operation. The blood pressure,heart rate,the time of breath recovery and extubation,move restlessly and bucking and the number of patients with bad memories in two groups before anesthesia( T1 ) ,at the time of extubation( T2 ) ,and after 1 min( T3 ) ,3 min ( T4 ) ,and 5 min( T5 ) of extubation were recorded. Results:Compared with the group R,the blood pressure and heart rate in group C were significantly increased at T2,T3,T4 and T5(P<0. 01),the incidence rate of move restlessly and bucking in group C at waking up was significantly increased(P<0. 01). The differences of the time of breath recovery and extubation between two groups were not statistically significant(P>0. 05). The number of patients with bad memories in group C after extubation were significantly higher than those in group R(P<0. 01). Conclusions:The treatment of 4 ng/ml of remifentanil by TCI can effectively relieve the cardiovascular reaction during general anesthesia recovery period,steady bloodstream dynamics and improve the comfort level of patients.