小剂量瑞芬太尼靶控输注联合右美托咪啶抑制气管拔管期呛咳反应的临床研究

Clinical study of target controlled infusion of a low- dose remifentanil combined with dexmedetomidine for cough suppression during tracheal extubation

目的观察小剂量瑞芬太尼靶控输注（TCI）联合右美托咪啶用于抑制气管拔管期呛咳反应的临床效果。方法 120例ASAⅠ~Ⅱ级,拟择期全麻下行鼻内窥镜手术的患者,随机分为两组,右旋美托咪啶组（D组）和对照组（C组）,每组60例。手术结束前10 min,D组输注右美托咪啶负荷剂量0.5μg/kg,C组给予等容量生理盐水,同时将瑞芬太尼TCI效应室靶浓度调为1 ng/ml,直至气管导管拔出才停止输注。记录麻醉诱导前、输注Dex或生理盐水前和后、睁眼时、拔管时、拔管后10 min的MAP、HR、RR以及呛咳评分。结果气管拔管期,D组的呛咳反应发生率明显低于C组,C组MAP、HR高于D组,两组RR无统计学差异。D组拔管时间稍长于C组,但无统计学差异。结论小剂量瑞芬太尼靶控输注（TCI）联合右美托咪啶能显著抑制气管拔管期呛咳反应,血流动力学更平稳,不延长苏醒时间。

Objective To investigate the effect of a low -dose remifentanil combined with dexmedetomidine infusion on cough suppression during tracheal extubation .Methods American Society of Anesthesiologists physical status I -II adults undergoing elective endoscopic sinus surgery under sevoflurane anesthesia were recruited and randomly allocated to receive either dexmedetomidine 0.5μg/kg iv （ Group D,n=60） or saline （Group C,n=60）, each combined with a low -dose remifentanil infusion ten minutes before the end of surgery.Coughing was assessed using a four -point scale.The respiratory rate （RR）, heart rate （HR）, and mean arterial pressure were also recorded .Results The incidence of coughing was lower in Group D than in Group C （P 〈0.05）.Mean arterial pressure and HR were elevated in Group C during tracheal extubation compared to baseline values in Group D .There was no difference in RR between the two groups throughout the study.A small delay in extubation was observed in Group D （ P 〉0.05）.Conclusions Compared with an infusion of low -dose remifentanil alone, the addition of a single dose （0.5μg/kg） of dexmedetomidine was effective in attenuating coughing during tracheal extubation and with little hemodynamic changes and did not exacerbate awake time after endoscopic sinus surgery .