瑞芬太尼与右美托咪定用于预防全麻苏醒期呛咳反射及血流动力学波动的比较

Comparison of Remifentanil with Dexmedetomidine in prevention of coughing and hemodynamic instability during emergence from general anaesthesia

目的对比瑞芬太尼靶控输注和单次给予右美托咪定预防全麻苏醒期呛咳反射和稳定血流动力学的效果。方法选择甲状腺切除手术患者90例,随机分为对照组(C组,n=30)、瑞芬太尼组(R组,n=30)和右美托咪定组(D组,n=30)。术中以七氟烷和靶控输注瑞芬太尼维持麻醉。D组于手术结束前10 min经静脉缓慢滴注0.5μg/kg右美托咪定。手术结束即刻,C组和D组同时停止输注瑞芬太尼;R组维持瑞芬太尼2 ng/m L靶控输注直至拔管结束。记录拔管期间患者呛咳评分、BP、HR、拔管后呼吸频率、镇静评分和咽痛评分。结果拔管期间呛咳评分为0分(无呛咳)或1分(1次呛咳)的患者的比例在R组(73.3%)显著高于C组(40%)和D组(40%)(P<0.05);R组MBP显著低于C组和D组(P<0.05);R组和D组HR均低于C组(P<0.05)。结论全麻醉苏醒期间,瑞芬太尼靶控输注在预防呛咳反射及血压升高方面效果优于单次给予右美托咪定;两者在稳定心率方面效果相当;拔管后两者均无明显呼吸抑制作用。

Objective To compare the effects of remifentanil target-controlled infusion （TCI） and dexmedetomidine single-dose administration on the prevention of cough and hemodynamic instability during anesthetic emergence.Methods Ninety elective thyroidectomy patients were randomly assigned to control group （group C,n =30）,Remifentanil group （group R,n =30） or Dexmedetomidine group （group D,n =30）.Anesthesia was maintained with sevoflurane and effect-site target-controlled infusion of remifentanil.In group D,remifentanil was discontinued,and dexmedetomidine 0.5 μg/kg was given 10 minutes before the end of surgery.In group C and group D,remifentanil was discontinued at the end the surgery.In group R,remifentanil TCI at an concentration of 2.0 ng/mL was maintained during emergence until extubation.The cough score,hemodynamic values,and other recovery profiles were evaluated during the peri-extubation period.Results During extubation,the proportion of patients with no cough or just a single cough was significantly higher in group R than in group D and group C （73.3％ vs 40％ and 40％,P ＜ 0.05）;MBP was lower in group R than in group C and group D （P ＜ 0.05）;HR were lower in group R and group D than in group C （P ＜ 0.05）.Conclusions Remifentanil TCI prevent cough and blood pressure increase during emergence from general anesthesia more effectively than single-dose dexmedetomidine.Both of the drugs had the same effect on maintain heart rate stability,and had no respiratory suppression effect.