布托啡诺、曲马多与瑞芬太尼在高血压患者全麻拔管期的临床观察比较

Comparison of effects of butorphanol and midazolam VS. remifentani on anesthesia extubation in patients with hypertension

目的观察布托啡诺与曲马多与瑞芬太尼对全麻高血压患者气管拔管时心血管反应及术后不良反应的预防作用。方法选择全身麻醉的高血压患者80例,随机分为对照组(I组)、布托啡诺组(II组)、曲马多(III组)和瑞芬太尼组(Ⅳ组)。四组麻醉诱导及维持方式相同。拔管前分别予0.9%等体积生理盐水,0.02mg/kg布托啡诺,2mg/kg曲马多及1μg/kg瑞芬太尼。记录各时点SBP、DBP、HR、SpO2,比较各组拔管时间、术后不良反应。结果 II、III、Ⅳ组患者围术期SBP、DBP、HR、SpO2变化平稳,明显优于I组,恶心、呕吐、躁动等的发生率也少于I组(P<0.05)。结论高血压患者在拔除气管导管前给予布托啡诺、曲马多及瑞芬太尼均能有效预防气管拔管时的心血管反应,且不良反应少。

Objective To observe the prevention effects of using but0rphanol and midazolam vs remifentani on anthesia extubation induced cardiovascular and postoperation adverse reaction. Methods 80 patients with primary hypertension were di- vided into 4 groups at random, controlled group （Ⅰ group）, butorphanol group （Ⅱ group）, midazolam group （Ⅲ group） and remifentani group（ Ⅳ group） . Used the same method of anesthesia induction and maintenance among 4 groups. Before extuba- tion, the O. 9% normal saline, butorphanol 0. 02 mg/kg, 2mg/kg midazolam and 1μg/kg remifentani were injected respectively for the 4 groups. The parameters of SBP,DBP,HR,SpO2and postoperative side effects were recorded. Results The extubation SBP,DBP,HR,SpO2of group Ⅱ group Ⅲ and group Ⅳ were keeping more stable than group Ⅰ（P 〈0. 05）. The nmnber of patients with nausea and vomiting, restlessness in group 1 was more than other 3 groups. Conclusion Using of butorphanol , midazolmn and remifentani in patients with hypertension can effectively prevent tracheal extubation induced cardiovascular response and ,with less adverse reactions.