持续小剂量瑞芬太尼靶控输注对全凭静脉麻醉脊柱侧弯术中唤醒质量的影响

The effect of maintaining a remifentanil target infusion on the quality of wake-up test during scoliosis surgery under total intravenous anesthesia

目的探讨丙泊酚联合瑞芬太尼全凭静脉麻醉用于脊柱侧弯矫形术时,术中唤醒试验时继续持续小剂量瑞芬太尼靶控输注能否改善术中唤醒质量。方法择期脊柱侧弯后路矫形手术患者40例,随机分为对照组(开始唤醒试验时停用丙泊酚和瑞芬太尼,n=20)和小剂量瑞芬太尼组(开始唤醒试验时停用丙泊酚但继续小剂量靶控输注瑞芬太尼,n=20)。记录2组患者开始唤醒试验时(T0)、遵指令活动手时(T1)、遵指令活动脚时(T2)的丙泊酚和瑞芬太尼效应室浓度及总用量,并观察唤醒时间及唤醒质量。结果对照组患者T0至T1时间间隔为(10.28±3.46)min,T0至T2时间间隔为(11.72±5.70)min;小剂量瑞芬太尼组T0至T1时间间隔为(11.15±3.91)min,T0至T2时间间隔为(11.92±3.57)min,组间差异无统计学意义。但对照组唤醒试验质量评分为1.89±0.63,小剂量瑞芬太尼组为1.34±0.63,实验组显著优于对照组(P<0.05)。结论丙泊酚联合瑞芬太尼全凭静脉麻醉用于脊柱侧弯矫形术时,术中唤醒试验时继续持续小剂量瑞芬太尼靶控输注可以显著改善唤醒质量,且不延长唤醒时间。

Objectives To explore whether maintaining low dose remifentanil target controlled infusion （TCI） during wake-up test can improve the quality of wake-up test for patients undergoing posterior instrumentation for the correction of scoliosis under total intravenous anesthesia with propofol and remifentanil. Methods Forty elective scoliosis surgical patients were randomized into two groups： the control group （n=20, both propofol and remifentanil infusion were suspended since wake-up test started） and low dose remifentanil group（n=20, maintaining low dose remifentanil target controlled infusion while propofol infusion were suspended since wake-up test started）. The time points of wake-up test started （T0）, hands moving followed with command（T1）, feet moving followed with command（T2） were recorded, as well as corresponding total consumption and effectsite concentration of propofol and remifentanil at each time point. Wake-up time and wake-up quality were also recorded. Results The interval of T0 to T1 was （10.28±3.46） min, and the interval of T0 to T2 was （11.72±5.70）min in the control group, while the interval of T0 to T1 was （11.15±3.91） min, and the interval of T0 to T2 was （11.92±3.57）min in low dose remifentanil group. There was no significant difference in wake-up time between the two groups. However, the quality score was significantly lower in low dose remifentanil group （1.34±0.63）, while it was 1.89± 0.63 in the control group （P 0.05）. Conclusion Maintaining low dose remifentanil target controlled infusion （TCI） during wake-up test can improve wake-up quality and does not prolong wake-up time for patients undergoing posterior instru- mentation for correction of scoliosis under total intravenous anesthesia with propofol and remifentanil.