瑞芬太尼在阻塞性睡眠呼吸暂停综合征术中的应用

Application of remifentanil in operation of obstructive sleep apnea-hypopnea syndrome

目的:观察阻塞性睡眠呼吸暂停低通气综合征病人手术过程中使用瑞芬太尼对术后苏醒的影响。方法:40例手术治疗阻塞性睡眠呼吸暂停低通气综合征的病人,随机分为2组。瑞芬太尼组气管插管后以丙泊酚和瑞芬太尼维持麻醉;复合麻醉组气管插管后术中以异氟醚和丙泊酚维持麻醉。观察2组病人术中血流动力学变化和术后的苏醒情况。结果:2组病人术后自主呼吸恢复时间、T1/TC=90％的时间、呼之睁眼时间、拔管时间、定向力恢复时间、病人离开恢复室时间瑞芬太尼组低于复合麻醉组(P<0．01)。病人拔管后即刻、30 min的意识状态和认知功能评分瑞芬太尼组高于复合麻醉组(P<0．01),而疼痛程度无显著差异(P>0．05)。拔管后瑞芬太尼组发生眩晕3例、躁动2例,复合麻醉组分别为13例和16例,有非常显著差异(P<0．01)。结论:瑞芬太尼在阻塞性睡眠呼吸暂停低通气综合征术中使用对改善病人术后苏醒有明显优势。

AIM： To observe the effect of remifentanil on analepsia after surgical operation in patients with obstructive sleep apnea-hypopnea syndrome. METHODS： Forty patients were enrolled according to the American Society of Anesthesilologists （ASA） Ⅰ -Ⅱ , with obstructive sleep apnea-hypopnea syndrome undergoing surgical therapy. All patients were randomly divided into two groups. After tracheal intubation, propofol and remifentanil were used as maintaining anaesthesia in the remifentanil group; and propofol with isoflurance were used as maintaining anaesthesia in the compound anesthesia group. The hemodynamics during the whole course of operation and analepsia after post-operation were observed. RESULTS： The time of spontaneous breath, the time of T1/Tc = 90 %, the time of openning eyes after being shouted, the time of extubation, the coincidnece time of orientation force, and the time of patients leaving recovery room in remifentanil group were lower than those in compound anesthesia group with significant difference （P 〈 0.01 ） . The scores of conscious states and the function of cognition at instant and 30min after extubation in remifentanil group were higher than those in compound anesthesia group （P 〈 0.01 ）, but no significant difference in pain sensation between the two groups （P 〉 0.05） . The number of patients being dizzy or restless in remifentanil group were 3 and 2, and those in compound anesthesia group were 13 and 16, with significant difference between the two groups after extubation （P 〈 0.01 ）. CONCLUSION： Remifentanil possesses evident advantages in analepsia after application in the course of operation for patients with obstructive sleep apnea-hypopnea syndrome.