小剂量瑞芬太尼在全麻后抑制气管拔管心血管反应的临床效果分析

摘要

Objective To study the effect of small‐dose remifentanil on suppressing cardiovascular responses to tracheal extubation after general anesthesia .Methods A total of 80 patients classified in ASA Ⅰ - Ⅱundergoing elective surgery under general anesthesia were enrolled in this study ,and randomly divided into observation group and control group ,with 40 cases in each group .The same induction and maintenance of anesthesia were given to the two groups .After operation remifentanil was continuously infused in the observation group ,and physiological saline was used in the control group as an alternative .Once the indication of tracheal extubation appeared ,tracheal extubation was conducted .The heart rate (HR) ,oxygen saturation (SpO2 ) ,systolic pressure (SBP) ,diastolic pressure (DBP) and other vital signs ,anesthesia recovery indicators and untoward reaction were recorded before tracheal extubation , tracheal extubation ,and 1 ,3 ,5 min after tracheal extubation .Results There were no significant differences of HR , SPO 2 ,SBP and DBP at the time of tracheal extubation ,and 1 ,3 ,5 min after tracheal extubation in the observation group ,compared with those before tracheal extubation(P>0 .05) ,while there were significant differences in the con‐trol group(P<0 .05) .There were significant differences of these indicators between observation group and control group at the time of tracheal extubation ,and 1 ,3 ,5 min after tracheal extubation(P<0 .05) .There were no signifi‐cant differences of spontaneous breathing recovery time ,the time of tracheal extubation and safe consciousness time compared between observation group and control group(P< 0 .05) .The incidence of untoward reaction in the ob‐served group(5 .0% ) was obviously lower than that in the control group(25 .0% ) ,with significant difference(P<0 . 05) .Conclusion Small‐dose remifentanil could effectively suppressing cardiovascular response to tracheal extuba‐tion ,with significant clinical effect and without obvious untoward reactions ,which would be worthy to widely use in clinical practice .%目的：研究分析小剂量瑞芬太尼在全麻后抑制气管拔管心血管反应的临床效果。方法选取淮南市第一人民医院收治的80例美国麻醉师协会评分（ASA）Ⅰ‐Ⅱ级择期行全麻手术患者，随机双盲法分为观察组和对照组，各40例。两组均给予相同的麻醉诱导和麻醉维持，术后观察组持续泵注瑞芬太尼，对照组输注生理盐水代替瑞芬太尼，待有拔管指征时，拔除气管导管。记录两组患者拔管前、拔管即刻、拔管后1、3、5min时的心率（HR）、血氧饱和度（SpO2）、收缩压（SBP）、舒张压（DBP）等生命体征，麻醉恢复指标及不良反应发生情况。结果观察组拔管即刻、拔管后1、3、5min时的HR、SpO2、SBP、DBP与拔管前相比，差异无统计学意义（均P＞0．05）；对照组拔管即刻、拔管后1、3、5min时的HR、SBP、DBP与拔管前相比，差异有统计学意义（均P＜0．05）。观察组拔管即刻、拔管后1、3、5min时的各指标与对应时段对照组相比，差异有统计学意义（均P＜0．05）；观察组自主呼吸恢复时间、拔管时间以及清醒时间与对照组相比，差异无统计学意义（P＞0．05）；观察组不良反应发生率（5．0％）明显低于对照组（25．0％），对比差异具有统计学意义（P＜0．05）。结论小剂量瑞芬太尼可有效缓解全麻后围拔管期心血管反应，临床效果显著，无明显不良反应，值得临床广泛推广。