帕瑞昔布、舒芬太尼对预防雷米芬太尼苏醒期躁动的比较

The comparation of the methods of parecoxib-sodium an sufentanil on preventing the restlessness during emergence after remifentanil-based general anesthesia

目的探讨雷米芬太尼麻醉后苏醒期躁动的预防方案。方法 90例ASAⅠ或Ⅱ级的择期腹腔镜胆囊切除术患者,随机分为帕瑞昔布40mg组（A组）,舒芬太尼0.1μg.kg-1（B组）舒芬太尼0.3μg.kg-1（C组）,每组30例。术毕前30min缓慢静脉输入。观察各组的HR、MAP、SpO2、PETCO2、躁动评分（RS）、Ramsay镇静评分（RSS）、意识状态评分（OAAS）。观察时点：术毕前30min给药时（T1）、给药后10min（T2）、30min（术毕停药）（T3）、拔管前（T4）、拔管时（T5）、拔管后10min（T6）、30min（T7）。以及T4、T5时血浆皮质醇、血糖,全麻后身体舒适度评分（BCS）、拔管时间（术毕到拔管）、病人静脉自控镇痛（PCIA）用量和副作用。结果 RS：T4~T7时B组分值高于A、C组（P〈0.05）。RSS：C组在T4~T6时分值高于A、B组（P〈0.05）。OAAS：T4~T6时A、B组高于C（P〈0.05）。BCS：B组分值低于A、C组（P〈0.05）.与T4比较B组T5时皮质醇和血糖的升高值高于A、C组（P〈0.05）。A、B组的无明显副作用,C组的主要副作用为呼吸抑制和尿潴留。结论静注帕瑞昔布40mg预防雷米芬太尼全麻醉后苏醒期躁动最佳,苏醒质量高,副作用少,术后镇痛药的用量明显减少。

OBJECTIVE To investigate the proposal of preventing the restlessness during emergence after remifentanil-based general anesthesia.METHODS ninty ASA classⅠorⅡpatients undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly assigned into 3 groups of A、B and C with 30 cases each.Thirty minutes before the end of surgery,parecoxi-sodium 40mg and sufentanil 0.1,0.3μg·kg-1 were administered in groups A and groups B、C respectively.HR、MAP、SpO2、PETCO2,Restlessness Score（RS）,Ramsay Sedative Score（RSS）,Observer′s Assessment of Alertness Sedation Score（OAAS） were recorded at 30 min before drug administ ration（T1）,10min（T2）,30min（T3） after that,before extubation（T4）,during extubation（T5）,and 10min（T6）,30min（T7） after extubation.In addition,cortisol and glucose in plasma at T4 and T5,Body Comfort Score（BCS）,extubation time,patient-controlled intravenous analgesia（PCIA） dosage and side reactions were observed.RESULTS The RS of group B were apparently higher than group A、C at T4-T7（P〈0.05）,Therewere statistically significant differences of the RS.The RSS of group C were apparently higher than group A、B at T4-T6（P〈0.05）.There were remarkable differences in OAAS at T4-T6（A、B vs C P〈0.05）.The BCS of A、C was obviously higher that of than B（P〈0.05）.There were great differences in the increase a values of cortisol and glucose from T4 to T5（A、C vs B,P〈0.05）.while the main side effects of group C were urine retention,the inhibition of respiratory system.CONCLUSION The application of parecoxi-sodium 40mg can safely and perfectly prevent the restlessness during emergence after remifentanil-based general anesthesia,which will produce few side effects and reduce the of PCIA dosage after operation.