小剂量瑞芬太尼复合丙泊酚抑制胃癌根治术后气管拔管应激反应

Small dose remifentanil and propofol attenuate stress responses induced by tracheal extubation in patients undergoing radical gastrectomy

目的观察全麻胃癌根治术后联合应用小剂量瑞芬太尼和丙泊酚抑制气管拔管时的应激反应。方法50例胃癌根治术患者随机分为实验组和对照组,每组25例,手术结束后实验组静脉注射丙泊酚0.3mg/kg、瑞芬太尼0.5μg/kg,对照组静脉注射相同容积的生理盐水。记录拔管前后两组患者血流动力学、呼吸、拔管时间和副反应等。结果拔管后3minSBP、DBP升高幅度实验组低于对照组(P<0.05);拔管后1minHR增快幅度实验组低于对照组(P<0.05)。拔管后实验组2例嗜睡;对照组1例恶心,10例发生谵妄烦燥需给镇静药物,实验组明显低于对照组(P<0.05)。结论全麻胃癌根治术后联合应用小剂量瑞芬太尼和丙泊酚可以有效抑制气管拔管时的应激反应。

Objective To evaluate the effect of small dose remifentanil and propofol on stress responses induced by tracheal extubation in patients undergoing radical gastrectomy. Methods Fifty ASA Ⅰ- Ⅱ patients undergoing radical gastrectomy for stomach cancer were randomly divided into test group and control group. At the end of surgery, a bolus dose of remifentanil and propofol was given to test group, and an equivalent volume of saline was given to control group. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, respiratory rate （RR）, the time from the end of surgery to tracheal extubation and side effects were recorded. Results SBP, DBP, HR and RR in two groups were increased 3 min after tracheal extubation （P〈0. 05） with the difference being significant between two groups （P〈0. 05）. There was significant difference in the side effects between two groups after extubation （P〈0. 05）. Conclusion Small dose remifentanil and propofol attenuated stress responses induced by tracheal extubation in patients undergoing radical gastrectomy.