舒芬太尼、曲马多对雷米芬太尼苏醒期躁动的预防效应

Effect of sufentanil and tramadol on preventing the restlessness during emergence after remifentanil-based general anesthesia

目的探讨雷米芬太尼麻醉后苏醒期躁动的预防方案。方法180例ASAⅠ或Ⅱ级的择期腹腔镜胆囊切除术患者，随机分为曲马多1、2、3mg／kg组（Q1、Q2、Q3组），舒芬太尼0．1、0．2、0，3／μg／kg组（S1、S2、S3组），每组30例。术毕前30min缓慢静脉输入。观察各组的HR、MAP、SpO2、PETCO2、躁动评分（RS）、Ramsay镇静评分（RSS）、意识状态评分（OAAS）。观察时点：术毕前30min给药时（T1）、给药后10min（T2）、20min（T3）、30min（术毕停药）（T4）、40min（T5）、拔管前（T6）、拔管时（T7）、拔管后10min（T8）、20min（T9）。以及T6、T7时血浆皮质醇、血糖，全麻后身体舒适度评分（BCS）、拔管时间（术毕到拔管）、病人静脉自控镇痛（PCIA）用量和副作用。结果RS：T4～T8时Q1、Q2组分值高于Q3组（P〈0.05），Q3组高于S1、S2、S3组（P〈0．05）；T9时Q1、Q2组分值高于Q3、S1、S2、S3组（P〈0．05）。RSS：Q3、S1、S2、S3组在T6～T8时分值高于Q1、Q2组（P〈0．05）。OAAS：T6～T9时舒芬太尼组高于曲马多组（P〈0．05），T6时S1、S2、S3组组间差异有统计学意义（P〈0.05）。BCS：Q1、Q2、Q3组分值低于S1、S2、S3组（P＜0．05）。与T6比较，Q1、Q2、Q3组T7时皮质醇和血糖的升高值高于S1、S2、S3组（P〈0．05），Q1、Q2、Q3组按剂量递减（P〈0．05）。Q3组的主要副作用为呕吐，S3组的主要副作用为呼吸循环抑制和尿潴留。结论0.2μg／kg舒芬太尼预防雷米芬太尼麻醉后苏醒期躁动最佳，苏醒质量高，副作用少，术后镇痛药的用量明显减少。

Objective To investigate the proposal of preventing the restlessness during emergence after remifentanil-based general anesthesia. Methods One hundred and eighty ASA class Ⅰ or Ⅱ patients undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly assigned into 6 groups of Q1 , Q2, Q3 ,S1, S2, and S3 with 30 cases each. Thirty minutes before the end of surgery, tramadol 1, 2, 3 mg/kg and sufentanil 0.1, 0.2, 0.3 μg/kg were administered in groups Q1 , Q2 , Q3 and groups S1 , S2 ,S3 respectively. HR, MAP, SpO2 , PETCO2 , Restlessness Score （RS）, Ramsay Sedative Score （RSS）, Observer/s Assessment of Alertness/ Sedation Score （OAAS） were recorded at 30 rain before drug administration（T1 ）, 10 min（T2 ）, 20 rain （T3） ,30 rain（T4 ） ,40 min（T5 ） after that, before extubation（T6 ）, during extubation（T7 ）, and 10 rain （T8） ,20 rain（T9 ） after extubation. In addition, cortisol and glucose in plasma at T6 and TT, Body Comfort Score （BCS）, extubation time, patient-controlled intravenous analgesia（PCIA） dosage and side reactions were observed. Results The RS of group Q1 and Q2 were apparently higher than group O3 at T6-T8 （P〈0.05）. The RS of group Q3were higher than group S1 , S2 and S3 （P〈0.05）. There were statistically significant differences of the RS at T9 （Q1, Q2 vs. Q3. S1 , S2 and S3, P〈0.05）. The RSS of groups Q3, S1, S2 and S3 were around 2 at T6-T9. The RSS of group Q1 and Q2 were about 1 at T6-T8. There were remarkable differences in OAAS at T6-T9 （Q1 , Q2 , O3 vs. S1, S2 , S3, P〈0. 05）. There were also significant differences in the values of OAAS in groups Q1 , Q2 and Q3 at T6. The BCS of sufentanil was obviously higher that of than tramadol （P〈0.05）. There were great differences in the increase a values of cortisol and glucose from T6 to T7 （Q1 , Q2, O3 vs. S1 , S2, S3 , P〈0. 05）. The values in them in group Q1 , Q2, O3 declined in an order of the dosages （P〈0. 05）. The major complication of group Q3 was vomit, while the main side effects of group S3 were urine retention, the inhibition of respiratory and circulatory system. Conclusion The application of 0.2 /μg/kg sufentanil thirty minutes before the end of surgery can safely and perfectly prevent the restlessness during emergence after remifentanil-based general anesthesia, which will produce few side effects and reduce the of PCIA dosage after operation.