小剂量丙泊酚复合雷米芬太尼对高血压病人围拔管期应激反应的影响

Effect on stress and cardiovascular response during extratubation in hypertension patients with a small dose of propofol pins remifentanyl

目的 拔管前应用小剂量丙泊酚复合雷米芬太尼持续输注,观察其对高血压病人围拔管期心血管反应及应激反应的抑制作用。方法 选择50例择期腹部手术的病人,随机分为治疗组和对照组,每组25例,在围拔管期应用小剂量的丙泊酚复合雷米芬太尼持续输注,观察记录麻醉前（T0）、用药后2 min（T1）、拔管时（T2）、拔管后5 min（T3）心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）、心率收缩压乘积（RPP）和呼吸频率（RR）的变化及T0、T2的血糖（GLU）、皮质醇（BS）水平。结果 HR、MAP、RPP在治疗组T1、T2、T3与T0相比差异无统计学意义。但与对照组比较显著降低（P〈0.05,P〈0.01）,而RR、SpO2在治疗组T1、T2及T0与对照组相比显著降低（P〈0.05）;T3时与T0比较显著增加（P〈0.05）,组间比较差异无统计学意义。结论 小剂量丙泊酚复合雷米芬尼对高血压病人围拔管期的应激反应有明显的抑制作用,值得推广。

Objective To observe inhibation of stress and cardiovascular response during extratubation in hyhpertesion patients with a small dose of propofol plus remifentanyl. Methods Fifty patients with hypertension undergoing selective upper abdominal surgery were located into control group and study group （ n = 25 for each）. The patients in study group received a small dose of propfol and remifentanyl and those in control group received normal saline. The changse of HR, PRR, SpO2, RR were recorded before induction of ansethasia （T0）, at 2 min after propofol infused （T1 ）, during exeratubation （T2 ）, at 5 min after extratubation （T3 ）. Meanwhile, the levels of GLU and BS at To, T2 ,were recorded in both groups. Results There was no significant increase in HR, MAP,RPP at T1 ,T2 , compared with To in study group,but were significaptly lower than that in control group （ P 〈0.05, P 〈0.01）. RR,SpO2 in study group were lower than that in control group（ P 〈 0.05）. RPP, MAP,HR in both groups at T3 were higher than that at To,but there was no statistical difference between two groups. The levels of GLU and BS increased more dramtically at T2 than that at To in both groups. GLU, BS of cotrol group increased far more dramatically than that in study group. Conclusion A small dose of propfol and remifentangle can significantly inhibit stress and cardiovascular response during extratubation in hyertension patients.