瑞芬太尼抑制恢复期拔除喉罩反应的最佳效应室浓度

Optimal effect-site concentration of remifentanil for inhibiting response to laryngeal mask airway removal during emergence

目的确定瑞芬太尼在抑制恢复期拔除喉罩反应时的最佳效应室浓度。方法将120例麻醉恢复期患者随机分为4组(R0、R0.5、R1.0和R1.5组),每组30例。R0、R0.5、R1.0和R1.5组瑞芬太尼效应室靶浓度分别为0、0.5、1.0和1.5μg·L^(-1)。记录恢复时间和不良反应,如呛咳、气道梗阻、闭气、血氧下降和躁动等发生情况。结果 R0、R0.5、R1.0和R1.5组出现呼吸系统并发症的例数分别是18、17、4和6例,其中呛咳发生率R1.0组(3.33%)和R1.5组(0)显著低于R0组(33.33%)(P<0.05),闭气发生率R1.0组(10%)显著低于R0组(33.33%)(P<0.05);Riker镇静躁动评分R1.0组和R1.5组与R0组比较差异有统计学意义(P<0.01),拔管时间R1.5组与其他组比较差异有统计学意义(P<0.05)。结论麻醉恢复期维持效应室浓度1.0μg·L^(-1)的瑞芬太尼可以减少拔管期呛咳、闭气、躁动等不良反应的发生且不影响恢复时间。

AIM To determine the optimal effect-site concentration of remifentanil for preventing complications associated with the removal of a laryngeal mask airway（ LMA）. METHODS A total of 120 patients were randomly assigned to 4 groups. They were remifentanil effect-site concentrations（ Ce） of 0 μg·L^-1（ group R0）,0.5 μg·L-（-1）（ group R0. 5）,1. 0 μg·L^-1（ group R1. 0）,and 1. 5 μg·L^-1（ group R1. 5） during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing,airway obstruction,breath-holding,desaturation,agitation,nausea,and vomiting were also evaluated. RESULTS The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in group R1. 0 and group R1. 5 than in group R0（ P 〈0. 05）. Emergence agitation also decreased in group R1. 0 and group R1. 5（ P 〈0. 001）. The time to LMA removal was significantly longer in group R1. 5 than in the other groups（ P 〈0. 05）. CONCLUSION Maintaining a remifentanil Ce of 1. 0 μg·L^-1during emergence may suppress adverse events such as coughing,breath-holding and agitation following the removal of LMA without delayed awakening.