比较听神经瘤切除术后苏醒期瑞芬太尼靶控输注下丙泊酚和地氟醚麻醉对气管拔管呛咳的影响

Comparison of effects of propofol and desflurane anesthesia on response to the tracheal tube with target-controlled infusion of remifentanil during recovery after vestibular schwannoma resection

目的比较听神经瘤切除术后苏醒期瑞芬太尼靶控输注下丙泊酚麻醉或地氟醚麻醉对拔管呛咳的影响。方法将2019年10月—2020年5月择期行听神经瘤切除术的60例患者随机分为丙泊酚麻醉组(n=30)或地氟醚麻醉组(n=30)。术毕停止给予丙泊酚或地氟醚,将瑞芬太尼效应室浓度设定为2 ng/mL,行靶控输注直至拔出气管导管。记录拔管呛咳的发生率和呛咳程度,同时记录拔管时血流动力学变化和苏醒情况。结果地氟醚组患者拔管呛咳发生率显著高于丙泊酚组(70.00%vs.19.23%,P<0.0001),而且呛咳程度评分更高(P=0.0004)。地氟醚组患者拔管时平均心率和动脉血压高于丙泊酚组(P<0.05),但丙泊酚组患者苏醒时间短于地氟醚组(P<0.05)。结论听神经瘤术后采用瑞芬太尼靶控输注下地氟醚麻醉的患者较丙泊酚麻醉的患者发生拔管呛咳的比例更高、程度更重且苏醒时间延长。

Objective To compare the effects of propofol and desflurane anesthesia on patients’responses to the tracheal tube with target-controlled infusion of remifentanil during recovery from general anesthesia after vestibular schwannoma resection.Methods Sixty patients undergoing vestibular schwannoma resection from Oct 2019 to May 2020 with general anesthesia were randomly assigned to propofol(group P,n=30)or desflurane anesthesia(group D,n=30).At the end of surgery,propofol or desfl urane was discontinued,and the remifentanil infusion was maintained at an effect-site concentration of 2.0 ng/mL until extubation.The incidence and severity of coughing,hemodynamic parameters and recovery profiles were evaluated.Results The incidence of coughing during the emergence was signi fi cantly higher in group D than that in group P(70.00%vs.19.2%,P<0.0001),and so was the grade of coughing(P=0.0004).The mean arterial pressure and heart rate were higher in group D than that in group P at extubation(P<0.05),but group P showed shorter recovery proflles(P<0.05).Conclusion In patients with target-controlled infusion of remifentanil after vestibular schwannoma resection,desflurane anesthesia causes higher incidence,more severity of coughing and longer recovery profile than propofol anesthesia at extubation.