术后持续输注瑞芬太尼可抑制全身麻醉下患者气管拔管时的应激反应。
Continuous postoperative infusion of remifentanil inhibits the stress responses to tracheal extubation of patients under general anesthesia.
作者信息
Zhao Guoliang, Yin Xiaoyue, Li Ya, Shao Jianlin
机构信息
Department of Anesthesiology, The First Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China.
出版信息
J Pain Res. 2017 Apr 19;10:933-939. doi: 10.2147/JPR.S123423. eCollection 2017.
PURPOSE
The study aimed to assess the combined effects of parecoxib with three different doses of remifentanil and its effect on the stress and cough responses following tracheal extubation under general anesthesia.
METHODS
A total of 120 patients with American Society of Anesthesiologists (ASA) scores of I or II, undergoing selective thyroidectomy with total intravenous anesthesia (propofol-remifentanil) and tracheal intubation, were randomly allocated to be treated with an intravenous injection of parecoxib and a continuous infusion of remifentanil at 0.1 μg/kg/min (R1), 0.2 μg/kg/min (R2), 0.3 μg/kg/min (R3), or an isotonic saline injection (the control group). Hemodynamic vital signs, emergence time, extubation time, sedation-agitation scale (SAS) score, pain visual analog scale (VAS) score, occurrence of coughing, and side effects were recorded before surgery and during the peri-extubation period. The vital signs included blood pressure (BP), heart rate (HR), respiratory rate (R), and peripheral arterial oxygen saturation (SPO).
RESULTS
BP, HR, the occurrence rate of coughing, and extubation awareness decreased with the dose of remifentanil, and the differences among the groups were significant ( < 0.05). Emergence and extubation time increased with the dose of remifentanil, and the differences among the groups were significant ( < 0.05). The occurrence rates of respiratory depression and bradycardia in group R3 were significantly higher than those in other groups ( < 0.05). SAS and VAS were lowest in group R3, and the differences among the groups were significant ( < 0.05). BP, HR, SAS, and VAS increased with time in the remifentanil groups.
CONCLUSION
The combined use of parecoxib and a moderate dose of remifentanil can effectively suppress the stress and coughing responses during the peri-extubation period. The appropriate quantity of remifentanil was found to be 0.2 μg/kg/min, as this dosage caused no side effects.
目的
本研究旨在评估帕瑞昔布与三种不同剂量瑞芬太尼联合使用的效果及其对全身麻醉下气管拔管后应激反应和咳嗽反应的影响。
方法
选取120例美国麻醉医师协会（ASA）分级为Ⅰ或Ⅱ级、接受全凭静脉麻醉（丙泊酚-瑞芬太尼）和气管插管的择期甲状腺切除术患者，随机分为静脉注射帕瑞昔布并持续输注0.1μg/kg/min瑞芬太尼（R1组）、0.2μg/kg/min瑞芬太尼（R2组）、0.3μg/kg/min瑞芬太尼（R3组）或注射等渗盐水（对照组）进行治疗。记录手术前及拔管周围期的血流动力学生命体征、苏醒时间、拔管时间、镇静-躁动评分（SAS）、疼痛视觉模拟评分（VAS）、咳嗽发生率及副作用。生命体征包括血压（BP）、心率（HR）、呼吸频率（R）和外周动脉血氧饱和度（SPO）。
结果
BP、HR、咳嗽发生率及拔管时意识随瑞芬太尼剂量增加而降低，组间差异有统计学意义（P<0.05）。苏醒和拔管时间随瑞芬太尼剂量增加而延长，组间差异有统计学意义（P<0.05）。R3组呼吸抑制和心动过缓发生率显著高于其他组（P<0.05）。R3组SAS和VAS最低，组间差异有统计学意义（P<0.05）。瑞芬太尼组BP、HR、SAS和VAS随时间增加。
结论
帕瑞昔布与中等剂量瑞芬太尼联合使用可有效抑制拔管周围期的应激反应和咳嗽反应。发现瑞芬太尼的合适剂量为0.2μg/kg/min，因为该剂量无副作用。
Zotero 插件