瑞芬太尼预注射抑制上肢手术止血带反应的临床研究

Effect of preemptive remifentanil on upper limb reaction caused by tourniquet

目的探讨预注射瑞芬太尼对上肢手术止血带反应的影响。方法选择上肢肘部以下手术行B超引导下肌间沟臂丛神经阻滞患者90例，采用随机数字表法分为R1组、R2组、C组，每组30例。神经阻滞完成后，R1组预注射瑞芬太尼0．6μg／kg（注射速度为0．55μg／s），R2组、C组预注射等速度等容量的0．9％氯化钠溶液，观察8min后R1组、R2组均持续输注瑞芬太尼0．05μg／（kg·min）（C组持续注射等速度等容量的0．9％氯化钠溶液）；记录麻醉前（T1）、臂丛阻滞后5min（T2）、预注射后（T3）、上止血带后15min（T4）、60min（T5）以及术毕时（T6）的BP、HR，并记录视觉模拟评分（VAS）和不良反应发生情况，以及持续监测使用瑞芬太尼期间RR、SpO2最低值、呼吸暂停时间。结果持续输注后RR、SpO2，R1组明显高于R2组，差异有统计学意义（P〈0.05）；R1组、R2组患者T3～T5时点MAP、HR较T1～T2时点有所下降，差异均有统计学意义（均P〈0．05），R2更为明显；R1、R2组VAS评分在T4、T5时点明显低于C组，差异有统计学意义（P〈0．05）。结论预注射0．6μg／kg（注射速度为0．55μg／s）瑞芬太尼可以明显减弱持续输注瑞芬太尼0．05μg／（kg·min）产生的呼吸抑制，且可以抑制上肢手术止血带反应。

Objective TO observe the clinical effect of the preemptive remifentanil on upper limb reaction caused by tourniquet. Methods Ninety ASA I - II patients undergoing tourniquet surgery were randomly divided into 3 groups with 30 cases in each group. Patients in group R1 received preemptive dosage of remifentanil 0.6 p g/kg followed by continuous infusion of 0.05 p g/kg/min; patients in group R2 received preemptive same volume normal saline, followed by continuous infusion of remifentanil 0.05 ~ g/kg/min; group C was the control group. Blood pressure （BP）, heart rate （HR）, the pain visual analog scores （VAS）, untoward effect were observed and recorded before and after anesthesia. Results The BP and HR in groups R1 and R2 15 rain and 60 min after tourniquet application were lower than before application （both P〈O.05）. The RR and Sp02 were better in group R1 than those in group R2 on the sequential continuous infusion （P〈O.05）. The VAS of groups R1 and R2 15rain and 60min after tourniquet application was lower than that of group C （P〈O.05）. respiratory depression of continuous infusion remifentanil, and can Conclusion Preinjection of remifentanil can attenuate the effectively reduce the upper limb reaction caused by tourniquet.