丙泊酚深度镇静下气管拔管的安全性评价

摘要

Objective To observe cardiovascular reaction and quality of consciousness recovery during tracheal extu-bation under deep sedation induced by propofol, and evaluate the security. Methods Totally 90 patients with tracheal intubation under general anesthesia were divided into 3 groups : Group C (Control group) : Extubation was performed when patients awaked autonomously; Group P; in the end of operation propofol was preserved pump-infusing until extubation; Group PF; propofol + fentanyl: fentanyl was injected intravenously 20 min before the end of operation and propofol was pump-infused continuously until extubation. The time ranges from muscle relaxants stopped to recovery of autonomous respiration , from the end of operation to extubation, from the end of operation to the time of leaving operation room was recorded. The changes of HR, MAP, SpO2, TOF and AAI before extubation (T0) , during extubation (T1) , 5 min after extubation (T2) , 10 min after extubation (T3). Meanwhile, Ramsay sedation scale (RSS) and restlessness score (RS) were performed at the same time point. Results ①HR and MAP at T1 were higher than those at T0 (P < 0. 05 ) ; Comparing with group C, HR and MAP at all time points in group P and PF were lower significantly (P < 0.05 ) ; MAP at T3 in group PF decreased significantly (P <0.05). ②Compared with group C, RSS at T0, T1 , T2 in group P and PF increased significantly ( P < 0.05 ). ③Compared with group C, RS at T0, T1 , T2 in group P and PF was decreased ( P < 0.05 ) ; Compared with group P, RS at T1, T2, T3 in PF was decreased significantly (P < 0.05). Conclusions Combination of analgesia of fentanyl and deep sedation of propofol during extubation repress various adverse effects such as cough, cardiovascular response and stress, and reduce anxiety and restlessness after extubation. Meanwhile, this method bring patients through anesthesia emergence safely and comfortably and improve quality of anesthesia.%目的 观察丙泊酚深度镇静下气管拔管时心血管变化及苏醒质量,并评价其安全性.方法 将90例全身麻醉气管插管手术患者分为3组:C组(对照组):术毕等患者自然苏醒拔除气管导管；P组:术毕保留丙泊酚持续泵注至拔管；PF组:手术结束前20 min静注芬太尼,丙泊酚持续泵注至拔管.记录停肌松剂至自主呼吸恢复、手术结束至拔管、手术结束至离开手术室的时间及拔管前(T0)、拔管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)HR、MAP、SpO2的变化,TOF值、AAI值,并进行镇静评分(RSS)、躁动评分(RS).结果 ①HR、MAP:各组T1时均较T0时升高(P均＜0.05),但P组、PF组各时间点均较C组降低(P＜0.05)；PF组在T3时,MAP降低更明显(P＜0.05)；②RSS:P组、PF组在T0、T1、T2均明显增高(P均＜0.05)；③RS:P组、PF组与C组比较在T0、T1、T2均明显降低(P均＜0.05)；PF组较P组在T1、T2、T3降低明显(P均＜0.05).结论 芬太尼镇痛与丙泊酚深度镇静下气管拔管能抑制拔管期间呛咳和心血管应激等各种不良反应,减少拔管后的焦虑和躁动,使患者安全、舒适地度过苏醒期,提高麻醉质量.