全麻苏醒拔管期雷米芬太尼靶控输注对心血管反应的影响

Remifentanil given by target-controlled infusion inhibits the cardiovascular response to emergence from anesthesia and tracheal extubation

目的 观察全麻苏醒拔管期雷米芬太尼靶控输注（TCI）对心血管反应的影响。方法 择期行妇科手术患者60例，ASAⅠ～Ⅱ级，随机均分为雷米芬太尼组（A组）和生理盐水对照组（B组）。两组患者均接受丙泊酚、维库溴铵、芬太尼、0．8％～1．0％异氟醚复合50％氧化亚氮的全身麻醉。术毕时送至麻醉复苏室（PACU），A组患者TCI输注雷米芬太尼，血浆浓度为1μg／L，B组TCI输注生理盐水作对照。观察苏醒期患者的平均动脉压（MAP）、HR、呼吸恢复时间、睁眼时间和拔管时间。结果 A组患者在吸痰、拔管时MAP、HR无明显变化，B组则明显升高（P〈0．05）；两组患者呼吸恢复、睁眼、拔管时间差异无显著意义。结论 TCI雷米芬太尼可抑制全麻苏醒拔管期的心血管反应，平稳苏醒。

Objective To study the effect of remifentanil given by target-controlled infusion （TCI） on the haemodynamic response to emergence from anesthesia and tracheal extubation. Methods Sixty ASA Ⅰ-Ⅱ female patients undergoing gynecological surgery were randomly assigned into two groups with 30 cases each： group A and group B. All patients received a standard general anesthesia with propofol, vecuronium, fentanil, 0. 8%-1% isoflunence with 50G nitrous oxide in oxygen. At the end of surgery, remifentanil was given by TCI at a fixed plasma concentration of 1μg/L in group A. Saline placebo was given in group B. Mean arterial pressure（MAP）, heart rate（HR）, the time of recovery of breathe, open eye and extubation was recorded. Results Remifentanil attenuated the increase in MAP and HR at sputum aspiration and extubation. There were no differences in the time of recovery of breathe, open eyes and extubation. Conclusion Remifentanil given by TCI inhibits cardiovascular response to emergence from anesthesia and tracheal extubation.