小剂量瑞芬太尼预防阻塞性睡眠呼吸暂停综合征手术拔管期心血管反应40例

Effect of Small Doses of Remifentanil on Preventing Cardiovascular Responses during Extubation in Operation of 40 Cases of Obstructive Sleep Apnea Hypoventilation Syndrome

目的研究小剂量瑞芬太尼在预防阻塞性睡眠呼吸暂停综合征(OSAHS)手术拔管期心血管反应的临床效果。方法随机选取全身麻醉下行OSAHS手术患者80例,采用随机双盲法分为治疗组和对照组各40例。两组麻醉诱导药物相同,术中麻醉维持药物均为七氟烷和瑞芬太尼。对照组手术结束时停止所有麻醉药;治疗组仅停止七氟烷,减少并持续输注瑞芬太尼直到拔管后。记录两组麻醉前(t1)、拔管时(t2),拔管后5 min(t3)、拔管后10 min(t4)、拔管后15 min(t5)的心率、收缩压、舒张压和血氧饱和度的变化、麻醉恢复指标及不良反应。结果两组在t2、t3、t4和t5时心率、收缩压、舒张压与麻醉前相比均有明显升高(P<0.05),两组血氧饱和度在拔管后各时间点与麻醉前相比有所下降(P>0.05)。治疗组在t2、t3、t4和t5时心率、收缩压和舒张压与对照组比较,差异有统计学意义(均P<0.05)。两组自主呼吸恢复时间、拔管时间和返回病房时间比较,差异无统计学意义(P>0.05)。治疗组不良反应发生率(7.5%)明显低于对照组(30.0%)(P<0.05)。结论小剂量瑞芬太尼可以有效预防OSAHS手术拔管期心血管反应,减少不良反应,提高拔管期安全性。

Objective To study the effect of small doses of remifentanil in preventing cardiovascular responses to extubation in the operation of obstructive sleep apnea hypoventilation syndrome(OSAHS).Methods Eighty patients with snoring under general anesthesia were selected.The patients were randomly divided into treatment group and control group with 40 cases in each group.The two groups used the same induction anaesthetics,and sevoflurane and remifentanil were used in both groups for anesthesia maintainance.The control group discontinued all anesthetics at the end of surgery;The treatment group stopped sevoflurane alone,and decreased and continued the infusion of remifentanil until extubation.The changes of heart rate,systolic blood pressure,diastolic blood pressure and oxygen saturation before anesthesia(t1),extubation(t2),5 min after extubation(t3),10 min after extubation(t4)and 15 min after extubation(t5)were recorded.Recovery indexesand adverse reactions of anesthesia were recorded.Results The heart rate,systolic blood pressure,diastolic blood pressure were significantly increased at t2,t3,t4 and t 5 in the two groups(P<0.05).SpO2 in all time intervals after extubation was slightly decreased,but the difference was not statistically significant(P >0.05).No significant differences were found between the two groups in the recovery time of spontaneous respiration,extubation time and the time returning to the ward(P >0.05).The incidence of adverse reactions was significantly lower in the treatment group(7.5%)than in the control group(30.0%)(P<0.05).Conclusion Small doses of remifentanil can effectively prevent the cardiovascular responses during extubation in OSAHS operations,reduce the adverse reactions and increase the safety of extubation.