不同剂量瑞芬太尼对下腹部手术患者全麻苏醒期躁动预防效果的对比研究

摘要

目的 比较不同剂量瑞芬太尼对下腹部手术患者全麻苏醒期躁动(EA)的预防效果.方法 选取2017年1—7月在鄂东医疗集团黄石市中心医院拟行全麻下下腹部手术患者160例,采用随机数字表法分为对照组(N组)、低剂量组(L组)、中剂量组(M组)及高剂量组(H组),每组40例.4组患者均在全麻下行下腹部手术, N组患者术后不给予瑞芬太尼,L组患者术后静脉泵注瑞芬太尼0.01 μg·kg-1·min-1,M组患者术后静脉泵注瑞芬太尼 0.02 μg·kg-1·min-1,H组患者术后静脉泵注瑞芬太尼 0.05 μg·kg-1·min-1.比较4组患者拔管前(T0)、拔管即刻(T1)、拔管后5 min(T2)、拔管后10 min(T3)、拔管后15 min(T4)平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS),拔管时间、苏醒时间、拔管后30 min疼痛视觉模拟量表(VAS)评分及术后Riker镇静和躁动评分(RSAS),并观察4组患者治疗期间不良反应发生情况.结果 时间与方法在MAP、HR、BIS上存在交互作用(P<0.05);时间在MAP、HR、BIS上主效应显著(P<0.05);方法在MAP、HR、BIS上主效应显著.T1~T4时L组、M组和H组患者MAP、HR低于N组,BIS高于N组(P<0.05);T1~T3时M组和H组患者的MAP、HR低于L组(P<0.05);T1~T4时M组和H组患者BIS高于L组(P<0.05).L组、M组、H组患者拔管时间和苏醒时间长于N组,拔管后30 min VAS评分及术后RSAS低于N组(P<0.05);M组和H组患者拔管时间和苏醒时间长于L组,拔管后30 min VAS评分及术后RSAS低于L组(P<0.05);H组患者拔管时间和苏醒时间长于M组,术后RSAS低于M组(P<0.05).H组患者治疗期间不良反应发生率高于L组、M组、N组(P<0.05).结论 瑞芬太尼0.02 μg·kg-1·min-1能有效维持下腹部术后患者血流动力学稳定,减轻术后疼痛及EA,且药物相关不良反应较少,但会延长患者拔管时间和苏醒时间.%Objective To compare the preventive effect of different doses of remifentanil on emergence agitation in patients undergoing hypogastric operation.Methods A total of 160 patients prepared for hypogastric operation were selected in Huangshi Central Hospital of Edong Medical Group from January to July 2017,and they were divided into N group,L group,M group and H group,each of 40 cases.All of the 160 patients received hypogastric operation under general anesthesia,thereinto patients in N group did not receive remifentanil after operation,while patients in L group received intravenous pumping of low-dose remifentanil(0.01 μg·kg-1·min-1),patients in M group received intravenous pumping of medium-dose remifentanil(0.02 μg·kg-1·min-1),patients in H group received intravenous pumping of high-dose remifentanil(0.05 μg·kg-1·min-1).MAP,HR and BIS before extubation(T0),immediately after extubation(T1),5 minutes after extubation(T2), 10 minutes after extubation(T3),15 minutes after extubation(T4),extubation time,awakening time,VAS score 30 minutes after extubation and Riker Sedation and Restlessness Score(RSAS) after operation were compared in the four groups, and incidence of adverse reactions was observed during the treatment.Results There was interaction between time and method in MAP,HR and BIS(P<0.05);main effects of time and method were significant in MAP,HR and BIS(P<0.05).From T1to T4,MAP and HR in L group,M group and H group were statistically significantly lower than those in N group,while BIS in L group,M group and H group was statistically significantly higher than that in N group,respectively(P<0.05);from T1 to T3,MAP and HR in M group and H group were statistically significantly lower than those in L group(P<0.05);from T1to T4,BIS in M group and H group was statistically significantly higher than that in L group,respectively(P<0.05).Extubation time and awakening time in L group,M group and H group were statistically significantly longer than those in N group,while VAS score 30 minutes after extubation and RSAS after operation in L group,M group and H group were statistically significantly lower than those in N group(P<0.05);extubation time and awakening time in M group and H group were statistically significantly longer than those in L group,while VAS score 30 minutes after extubation and RSAS after operation in M group and H group were statistically significantly lower than those in L group(P<0.05);extubation time and awakening time in H group were statistically significantly longer than those in M group,while RSAS after operation in H group was statistically significantly lower than that in N group(P<0.05).Incidence of adverse reaction in H group was statistically significantly higher than that in L group,M group and N group during the treatment,respectively(P<0.05).Conclusion In patients undergoing hypogastric operation,medium-dose remifentanil(0.02 μg·kg-1·min-1) can effectively maintain the postoperative hemodynamic stability,relieve the postoperative pain and emergence agitation with low risk of adverse reactions,but it may lengthen the extubation time and awakening time.