瑞芬太尼抑制胃癌手术全麻拔管时心血管反应的研究

Effect of remifentanil on cardiovascular responses induced by tracheal extubation in patients undergoing radical gastrectomy

目的：观察胃癌根治术全身麻醉气管拔管前应用瑞芬太尼对抑制气管拔管期心血管反应的可行性。方法：选择胃癌手术患者40例，ASA I-Ⅱ，随机分为，对照组和瑞芬太尼组，每组20例。所有病人接受同一标准的全身麻醉，缝皮结束时，分别静脉给予单次剂量的瑞芬太尼1μg·kg“或等容积的生理盐水。观察拔管前后血压、心率的变化，麻醉苏醒时间及并发症。结果：两组气管导管拔除的时间无差异。拔管前后，瑞芬太尼组收缩压、舒张压、心率无明显差异（P〉0．05），对照组拔管时及拔管后收缩压、舒张压、心率显著增高（P〈0.05）；两组比较有统计学差异（P〈0.05）。结论：胃癌手术拔管前使用单次剂量瑞芬太尼可以有效的抑制气管拔管期心血管反应，且不影响苏醒、不抑制呼吸。

Objective：To evaluate the efficacy of remifentanil on the cardiovascular responses to tracheal extubation in patients undergoing radical gastrectomy. Methods： Forty ASA Ⅰ-Ⅱ patients undergoing radical gastrectomy for stomach cancer , were randomly divided into two groups, remifen tanil group and saline（ control group）,20 in each All patients in twograups received a standard general anaesthetic including propofol, vecuronium and isoflurane. At the end of surgery, a bolus close of remifentanil or an equivalent volume of saline was given to two groups recpectively , tracheal extubation was performed when standard criteria were achieved. Arterial pressure and heart rate（HR） were recorded at 1,3,5 rain at the end of surgery. Results： Before and after operation systolic arterial pressure（ SAP）, diastolic arterial pressure（DAP） and HR at extubation in remifentanil group did not change significantly （P〉0.05 ）. SAP and DAP increased in saline group at extubation after extubation compared with the baseline values （ P〈0.05）. there were significant differences between two groups in SAP, DAP, and HR. Conclusion： Remifentanil attenuated the increase in both arterial pressure and heart rate, there was no difference in the incidence of adverse effects at extubation, time to recovery from anaesthesia comparod to control group.