右美托咪定和瑞芬太尼对七氟烷吸入全身麻醉患者苏醒期恢复质量影响的对比观察

摘要

目的 观察对比右美托咪定和瑞芬太尼对七氟烷吸入全身麻醉患者术后苏醒期恢复质量的影响.方法 选择择期全身麻醉下行胸腔镜肺叶切除手术、ASA Ⅰ～Ⅱ级、年龄37 ～ 65岁患者100例,按照不同麻醉维持方案随机将其分为两组:七氟烷+右美托咪定(D组,n =50),七氟烷+瑞芬太尼(R组,n=50).常规静脉诱导气管插管后,D组患者吸入1.5％七氟烷+静脉输注右美托咪定[0.2～1.0μg/(kg.h)],R组患者吸入1.5％七氟烷+静脉输注右美托咪定[4～ 10μg/(kg·h)].测量比较患者术中血流动力学指标.记录所有患者清醒和气管拔管的时间,统计患者恢复期严重咳嗽和躁动发生率.统计患者恢复室内严重疼痛、恶心、呕吐的发生率.测量比较患者术中血流动力学指标.结果 两组患者各时刻的血压和心率差异无统计学意义(P＞0.05).R组清醒时间(4.2±2.1min)和气管拔管时间(4.8 ±3.1min)显著短于D组(11.9±3.6min和14.2土4.3min,P＜0.05).两组患者躁动和严重咳嗽发生率比较差异无统计学意义(P＞0.05).D组患者恢复室内镇痛数字评分者和自述尿管相关膀胱不适症状发生率显著低于R组(24％ vs 52％,12％ vs 30％,JP＜0.05).结论 七氟烷全身麻醉患者术中联合输注右美托咪定或瑞芬太尼在控制苏醒期严重呛咳、躁动发生率方面具有类似的效果,瑞芬太尼在缩短清醒时间和气管拔管时间方面具有优势,右美托咪定在减少术后疼痛和尿管相关膀胱不适方面效果更好.%Objective To compare the effects of dexmedetomidine and remifentanil infusion on emergence and recovery characteristics of patients with thoracoscopic lobectomy following general anaesthesia with sevoflurane.Methods One hundred patients,who were aged 37 to 65 years with American Society of Anesthesiologists (ASA) physical status 1-2,and scheduled for elective thoracoscopic lobectomy under general anaesthesia,were allocated randomly to receive sevoflurane/dexmedetomidine maintenance regimen (group S,n =50) or sevoflurane/remifentanil maintenance regimen (group SR,n =50).After routine induction and intubation,anaesthesia was maintained with 1.5％ inhaled sevoflurane/dexmedetomidine[continuous intravenous infusion at rate of 0.2-1.0μg/(kg · h)] in group D and 1.5％ sevoflurane/remifentanil[continuous intravenous infusion at rate of 4-10μg/(kg · h)] in group R respectively.Haemodynamic variables were collected at different time points and compared between two groups.Awaking times and extubation times,incidences of serious coughing and agitation were evaluated during emergence.Postoperative pain,nausea and cather-related bladder discomfort (CRBD) were evaluated in post anesthesia care unit.Results There was no significant differences in the arterial blood pressure and heart rate between two groups at all the time points(P ＞ 0.05).Times to awaking and to extubation were shorter significantly in group R (4.2 ± 2.1 min and 4.8 ± 3.1 min) than in group D (11.9 ± 3.6min and 14.2 ± 4.3min) respectively (P ＜ 0.05).The incidences of serious coughing and agitation in group R were similar with group D (P ＞ 0.05).Compared with group R,the NRS,number of complaining CRBD were significantly lower in group D(24％ vs 52％,12％ vs 30％,P ＜ 0.05).Conclusion Dexmedetomidine and remifentanil had equal effectiveness in reducing serious coughing and emergence agitation in patients under general anesthesia with sevoflurane.Coadministration of remifentanil and sevoflurane maintenance regimen provides faster awakening and extubation,while dexmedetomidine is superior to remifentanil in reducing postoperative pain and CRBD.