右美托咪定复合瑞芬太尼对全麻气管拔管反应的影响

Effects of dexmedetomidine combined with remifentanil for extubation reaction after general anesthesia

目的:探讨右美托咪定(Dex)复合小剂量瑞芬太尼能否减少全麻气管拔管反应。方法:选择常规全麻并七氟烷吸入维持的甲状腺手术患者60例,随机分为右美托咪定组(D组,Dex负荷量0.4μg/kg后0.01μg·kg-1·min-1持续泵注)、小剂量瑞芬太尼组(R组,持续静脉靶控输注瑞芬太尼1.5 ng/m L效应室浓度)、Dex联合小剂量瑞芬太尼组(DR组,Dex负荷量0.4μg/kg后0.01μg·kg-1·min-1持续泵注复合静脉靶控输注瑞芬太尼1.5 ng/m L效应室浓度),每组20例。记录拔管前(T1)、拔管后1(T2)、5(T3)、10 min(T4)患者心率、血压及Sp O2,观察苏醒期患者睁眼时间、自主呼吸恢复时间、拔管时间、定向力恢复时间、拔管时呛咳情况;在PACU 5、10及20 min时行镇静评分。结果:三组各记录时点生命体征平稳。三组患者睁眼时间、自主呼吸恢复时间、拔管时间及定向力恢复时间比较差异无统计学意义(P>0.05)。DR组严重呛咳反应发生率较D组、R组显著减少(15%vs 55%vs40%,P<0.05)。三组患者在PACU 5、10、20 min镇静评分比较差异无统计学意义(P>0.05)。结论:Dex联合小剂量瑞芬太尼可有效减轻拔管期呛咳反应,且不影响患者清醒及拔管时间。

AIM： To investigate the effects of dexmedetomidine（ Dex） with low doses of remifentanil for achieving quiet extubation purpose during general anesthesia recovery period. METHODS：Sixty patients who were elected to schedule for thyroid surgery were randomly divided into three groups： group D（ Dex 0. 4 μg / kg as a loading dose and then 0. 01 μg·kg- 1·min- 1continuous intravenous infusion）,group R（ effect-site concentration of remifentanil 1. 5 ng / m L for target controlled infusion（ TCI）,group DR（ Dex 0. 4 μg / kg as a loading dose and then 0. 01 μg·kg- 1·min- 1continuous intravenous infusion,combined with 1. 5 ng / m L effect-site concentration of remifentanil TCI）. Indexes of heart rate（ HR）,blood pressure（ BP） and Sp O2 of the patient were observed and recorded at the time of during extubation（ T1）,1 min（ T2）,5mins（ T3）,10 mins（ T4） after extubation. The relative time such as eye opening,spontaneous breathing recovery,extubation,orientation recovery were recorded. The scores of cough and OAA / S sedation were also observed and recorded. RESULTS： Vital signs at each time points in three groups were stable. There were no significant difference in time of eye opening,spontaneous breathing recovery,extubation and orientation recovery among the three groups（ P〈0. 05）. The incidene of severe cough reaction was significantly reduced in DR group than in D group and R group（ 15% vs 55% vs 40%,P〈0. 05）. There were no significant differences in sedation scores among the three groups at 5,10 and20 min in PACU（ P〈0. 05）. CONCLUSION：Dexmedetomidine combined with low doses of remifentanil could effectively reduce cough response during extubation after thyroid surgery without affecting patient wake and extubation time.