首页> 中文期刊> 《医学综述》 >瑞芬太尼持续静脉输注对外耳再造手术小儿全身麻醉拔管的影响

瑞芬太尼持续静脉输注对外耳再造手术小儿全身麻醉拔管的影响

         

摘要

Objective To observe the effect of remifentanil infusion on circulatory response and extubation-related adverse effects to the children undergoing ear reconstruction surgery with general anesthesia in tracheal extubation period.Methods A total of 60 cases with Ⅰ-Ⅱ of ASA assessment rating,who would undergo elective ear reconstruction surgery with autologous rib cartilage were randomly divided into a remifentanil group and a control group,30 cases each.Both groups were induced by anesthesia sufentanil + propofol + rocuronium and maintained by anesthesia remifentanil + propofol + 60% N2O.Inhalation and intravenous anesthetics were discontinued 5 minutes before the end of the surgery.The patients in the remifentanil group were continuously injected remifentanil[0.05 μg/(kg · min] from the end of the surgery to extubation.The patients in the control group were not injected remifentanil from the end of the surgery to extubation.The spontaneous breathing recovery time,awaking time,extubation time,and the mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2) at the time points of before induction of anesthesia (T0),the end of the surgery (T1),extubation (T2),1 minute after extubation (T3),3 minutes after extubation (T4),5 minutes after extubation (T4) were recorded respectively.The responses to extubation,respiratory inhibition,nausea and vomiting in 5 min after extubation were recorded.Results MAP,HR of the two groups were significantly decreased at T1,increased at T2 and T3;while significantly decreased at T4 and T5,approaching to the level at T1 (P < 0.05).MAP at T2 and T3 were significantly higher than MAP at T0 in the control group(P<0.05).MAP at all the time points except T5 were significantly lower than MAP at T0 in the remifentanil group (P < 0.05).HR at T2 and T3 were significantly higher than HR at T0 in both groups (P < 0.05).MAP,HR at T2 and T3 in the remifentanil group were significantly lower than those in the control group (P < 0.05).SpO2 of the cases at the different time points had no significant differences in the remifentanil group and the control group(P > 0.05).The incidence of the response to extubation in the remifentanil group were significantly lower than that in the control group [(1.33 ± 0.60) scores vs (2.03 ± 0.90) scores,P < 0.05].There were no significant differences in spontaneous breathing recovery time,awaking time,extubation time and observer's assessment of alertness/sedation scale of the two groups (P > 0.05).The incidence of the respiratory inhibition,nausea and vomiting of the two groups had no statistically significant differences(P >0.05).Conclusion By continuous injection of remifentanil[0.05 μg/(kg · min)] on pediatric patients with general anesthesia in tracheal extubation period,it can significantly reduce the risk of cardiovascular reaction and the cough response,without prolonging anesthesia recovery time.%目的 观察瑞芬太尼持续输注对外耳再造手术小儿全身麻醉拔管的循环反应以及拔管相关不良反应的影响.方法 选取美国麻醉医师协会分级Ⅰ~Ⅱ级择期全身麻醉拟行自体肋软骨移植外耳再造手术患儿60例,按随机数字法分为对照组和瑞芬太尼组,每组30例.两组患儿的麻醉诱导均采用舒芬太尼+丙泊酚+罗库溴铵方案,麻醉维持采用瑞芬太尼+丙泊酚+60% N2O方案.两组均术毕前5 min停用吸入和静脉麻醉药物,瑞芬太尼组将瑞芬太尼浓度减至0.05 μg/(kg·min)持续输注直至拔出气管导管,对照组停瑞芬太尼输注.观察两组小儿麻醉诱导前(T0)、手术结束时(T1)、拔管前即刻(T2)、拔管后1 min(T3)、拔管后3min(T4)、拔管后5 min(T5)的平均动脉压(MAP)、心率和脉搏血氧饱和度(SpO2);记录自主呼吸恢复时间、苏醒时间、拔管时间;记录拔管时患儿呛咳反应状况,拔管后5 min内是否发生呼吸抑制及恶心呕吐.结果 两组患儿T1时间点MAP、心率出现明显降低,T2 、T3时间点的MAP、心率出现明显升高;T4、T5时间点MAP、心率出现降低,与T0时间点接近.对照组T2、T3的MAP明显高于T0 (P <0.05);瑞芬太尼组除T5外其余各时点MAP均明显低于T0(P<0.05).对照组和瑞芬太尼组T2、T3的心率均较T0明显加快,瑞芬太尼组T2、T3的MAP、心率较对照组明显下降(P<0.05).对照组和瑞芬太尼组各时点的SpO2均无明显变化(P>0.05).瑞芬太尼组的拔管呛咳反应评分显著低于对照组[(1.33士0.60)分比(2.03±0.90)分,P<0.05].两组患儿的自主呼吸恢复时间、苏醒时间、拔管时间、清醒镇静评分、呼吸抑制及恶心呕吐发生率差异无统计学意义(P>0.05).结论 小儿全身麻醉拔管期持续静脉输注瑞芬太尼0.05 μg/(kg · min),可以明显减轻拔管期间的心血管反应和拔管时的呛咳反应,且不延长麻醉恢复时间.

著录项

  • 来源
    《医学综述》 |2018年第6期|1244-1248|共5页
  • 作者单位

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

    中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类 口腔颌面部外科学;
  • 关键词

    瑞芬太尼; 持续输注; 小儿; 全身麻醉;

相似文献

  • 中文文献
  • 外文文献
  • 专利
获取原文

客服邮箱:kefu@zhangqiaokeyan.com

京公网安备:11010802029741号 ICP备案号:京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有
  • 客服微信

  • 服务号