瑞芬太尼不同用法对微创经皮肾镜碎石术后患者苏醒的影响

The effect of remifentanil with different administration on the recovery profiles during emergence from anaesthesia to those undergoing MPCNL

目的观察瑞芬太尼不同用法对微创经皮肾镜碎石术后患者苏醒的影响。方法选择ASA1～2级、无心肺脑合并症、拟行经皮肾镜碎石术的成年患者120例,随机分为芬太尼组(A组)、瑞芬太尼非全程输注组(B组)和瑞芬太尼全程输注组(C组)各40例。3组术前用药、麻醉诱导用药及方法相同,A组以术中间断注射芬太尼维持麻醉,B组于诱导后开始用微量泵连续静脉输入瑞芬太尼0.1～2μg(/kg·min),输注速率根据麻醉深度及生命体征变化调节,手术结束时立即停用瑞芬太尼;C组术中维持同B组,但在手术结束时将瑞芬太尼用量调整为维持剂量的1/5至1/10继续输注,直至拔除气管导管,麻醉期间常规监测有创血压(IBP)、心电图(ECG)、心率(HR)、血氧饱和度(SpO2)、脑电双频指数BIS。观察苏醒时间、拔管时间及术后躁动情况。结果芬太尼组(A组)睫毛反射、睁眼、拔管时间长于瑞芬太尼非全程输注组(B组)和瑞芬太尼全程输注组(C组),差异有统计学意义,瑞芬太尼全程输注组(C组)与A组和B组相比术后躁动发生率最低,有统计学意义。结论瑞芬太尼全程输注可显著降低微创经皮肾镜碎石术后患者躁动的发生,并且不延长患者苏醒时间。

Objective To observe the effect of remifentanil with different administration on the recovery profiles during emergence from anaesthesia to those undergoing MPCNL. Methods A total of 120 patients undergoing MPCNL under general anaesthesia using total i.v. anaesthesia （propofol and remifentanil） were randomly allocated to three groups： fentanyl group （group A）; remifentanil not maintaining infusion group （group B） and remifentanil maintaining infusion group （group C）, these three groups have same premedication and inducement of anesthesia. Group A received i.v fentanyl discontinuously. Group B and C received remifentanil continuously with speed 0.1-2 μg/（kg.min）from inducement of anesthesia to end of the operation, and at the end of surgery the infusion of remifentanil was stopped in group B and maintained in group C until extubation but the speed reduced to one fifth to one tenth of the maintenance rate. IBP, ECG, HR, SpO2, BIS and recovery profiles were measured and evaluated. Results It was found that time to extubation and eyes opening were significantly higher in the fentanyl group （group A） compared with the other two groups （group B and C） during emergence and tracheal extubation （P〈0.05）, and moreover, remifentanil maintaining infusion group （group C） had the lowest incidence of emergence delirium among the three groups （P〈0.05.） Conclusions For those undergoing MPCNL under general anaesthesia, low-dose remifentanil maintaining infusion during emergence reduced the incidence of emergence delirium and did not prolong wake-up.