国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
2期
111-114
,共4页
徐四七%王胜斌%居霞%肖敬波%胡胜红%李元海
徐四七%王勝斌%居霞%肖敬波%鬍勝紅%李元海
서사칠%왕성빈%거하%초경파%호성홍%리원해
瑞芬太尼%靶控输注%气管拔管%全凭静脉麻醉
瑞芬太尼%靶控輸註%氣管拔管%全憑靜脈痳醉
서분태니%파공수주%기관발관%전빙정맥마취
Remifentanil%Target-controlled infusion%Tracheal extubation%Total intravenous anesthesia
目的 观察全麻苏醒期维持静脉靶控输注瑞芬太尼(remifentanil,RF)对甲状腺手术患者血流动力学及呛咳发生率的影响.方法 甲状腺手术患者80例,年龄20岁～58岁,男41例,女39例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,按随机数字表法分为4组,每组20例,麻醉方法采用气管内静脉全麻,术中采用RF血浆靶控浓度维持4μg/L～6μg/L,丙泊酚血浆靶控浓度2.8 mg/L维持麻醉,手术结束缝皮时停止输注丙泊酚.调整血浆RF靶浓度分别为0(RF0.0组)、1.5(RF1.5组)、2.0 μg/L(RF20组)和2.5 μg/L组(RF25组)持续输注直至拔管后停止.评价血流动力学变化及呛咳的发生率和严重性. 结果 RF20组和RF25组拔管时呛咳的发生率和严重性明显低于RF0.0组(P＜0.05).与RF0.0组拔管即刻和拔管后1min平均动脉压(MAP)[(100±5)、(105±4) mm Hg(1mm Hg=0.133 kPa)]和心率(HR)[(104.9±5.1)、(118±5)次/min]比较,RF各组拔管即刻MAP[(95±4)、(87±4)、(82±4) mm Hg]、HR [(96.1±3.4)、(85.2±3.0)、(79.9±2.4)次/min]和拔管后1min MAP [(100±3)、(90±4)、(86±4) mmHg]、HR[(103±3)、(92±3)、(84±3)次min]明显降低,差异均有统计学意义(P＜0.05),RFF2.5组拔管即刻和拔管后1 minMAP[(82.44.3)、(85.7±4.0) mm Hg]和HR[(79.9±2.4)、(84.4±3.3)次/min]明显低于RFt5组MAP[(95±4)、(100±3)mm Hg]、HR[(96.1±3.4)、(103±3)次/min]和RF2.0组MAP[(87±4)、(90±4)mm Hg]、HR[(85.2±3.0)、(92±3)次min],差异均有统计学意义(P＜0.05).与RF0.0组睁眼时间和拔管时间[(8.0±0.6)、(9.8±0.5) min]比较,RF1.5组[(8.0±0.3)、(9.9±0.5) min]和RF2.0组[(8.2±0.3)、(10.1±0.4) min]差异无统计学意义,但RF2.5组[(8.3±0.5)、(11.6±0.7) min]明显延迟,差异均有统计学意义(P＜0.05). 结论 RF持续靶控输注可明显降低气管拔管相关血流动力学变化及呛咳反应,但随RF剂量增加,麻醉苏醒时间延迟.
目的 觀察全痳囌醒期維持靜脈靶控輸註瑞芬太尼(remifentanil,RF)對甲狀腺手術患者血流動力學及嗆咳髮生率的影響.方法 甲狀腺手術患者80例,年齡20歲～58歲,男41例,女39例,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級,按隨機數字錶法分為4組,每組20例,痳醉方法採用氣管內靜脈全痳,術中採用RF血漿靶控濃度維持4μg/L～6μg/L,丙泊酚血漿靶控濃度2.8 mg/L維持痳醉,手術結束縫皮時停止輸註丙泊酚.調整血漿RF靶濃度分彆為0(RF0.0組)、1.5(RF1.5組)、2.0 μg/L(RF20組)和2.5 μg/L組(RF25組)持續輸註直至拔管後停止.評價血流動力學變化及嗆咳的髮生率和嚴重性. 結果 RF20組和RF25組拔管時嗆咳的髮生率和嚴重性明顯低于RF0.0組(P＜0.05).與RF0.0組拔管即刻和拔管後1min平均動脈壓(MAP)[(100±5)、(105±4) mm Hg(1mm Hg=0.133 kPa)]和心率(HR)[(104.9±5.1)、(118±5)次/min]比較,RF各組拔管即刻MAP[(95±4)、(87±4)、(82±4) mm Hg]、HR [(96.1±3.4)、(85.2±3.0)、(79.9±2.4)次/min]和拔管後1min MAP [(100±3)、(90±4)、(86±4) mmHg]、HR[(103±3)、(92±3)、(84±3)次min]明顯降低,差異均有統計學意義(P＜0.05),RFF2.5組拔管即刻和拔管後1 minMAP[(82.44.3)、(85.7±4.0) mm Hg]和HR[(79.9±2.4)、(84.4±3.3)次/min]明顯低于RFt5組MAP[(95±4)、(100±3)mm Hg]、HR[(96.1±3.4)、(103±3)次/min]和RF2.0組MAP[(87±4)、(90±4)mm Hg]、HR[(85.2±3.0)、(92±3)次min],差異均有統計學意義(P＜0.05).與RF0.0組睜眼時間和拔管時間[(8.0±0.6)、(9.8±0.5) min]比較,RF1.5組[(8.0±0.3)、(9.9±0.5) min]和RF2.0組[(8.2±0.3)、(10.1±0.4) min]差異無統計學意義,但RF2.5組[(8.3±0.5)、(11.6±0.7) min]明顯延遲,差異均有統計學意義(P＜0.05). 結論 RF持續靶控輸註可明顯降低氣管拔管相關血流動力學變化及嗆咳反應,但隨RF劑量增加,痳醉囌醒時間延遲.
목적 관찰전마소성기유지정맥파공수주서분태니(remifentanil,RF)대갑상선수술환자혈류동역학급창해발생솔적영향.방법 갑상선수술환자80례,년령20세～58세,남41례,녀39례,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,안수궤수자표법분위4조,매조20례,마취방법채용기관내정맥전마,술중채용RF혈장파공농도유지4μg/L～6μg/L,병박분혈장파공농도2.8 mg/L유지마취,수술결속봉피시정지수주병박분.조정혈장RF파농도분별위0(RF0.0조)、1.5(RF1.5조)、2.0 μg/L(RF20조)화2.5 μg/L조(RF25조)지속수주직지발관후정지.평개혈류동역학변화급창해적발생솔화엄중성. 결과 RF20조화RF25조발관시창해적발생솔화엄중성명현저우RF0.0조(P＜0.05).여RF0.0조발관즉각화발관후1min평균동맥압(MAP)[(100±5)、(105±4) mm Hg(1mm Hg=0.133 kPa)]화심솔(HR)[(104.9±5.1)、(118±5)차/min]비교,RF각조발관즉각MAP[(95±4)、(87±4)、(82±4) mm Hg]、HR [(96.1±3.4)、(85.2±3.0)、(79.9±2.4)차/min]화발관후1min MAP [(100±3)、(90±4)、(86±4) mmHg]、HR[(103±3)、(92±3)、(84±3)차min]명현강저,차이균유통계학의의(P＜0.05),RFF2.5조발관즉각화발관후1 minMAP[(82.44.3)、(85.7±4.0) mm Hg]화HR[(79.9±2.4)、(84.4±3.3)차/min]명현저우RFt5조MAP[(95±4)、(100±3)mm Hg]、HR[(96.1±3.4)、(103±3)차/min]화RF2.0조MAP[(87±4)、(90±4)mm Hg]、HR[(85.2±3.0)、(92±3)차min],차이균유통계학의의(P＜0.05).여RF0.0조정안시간화발관시간[(8.0±0.6)、(9.8±0.5) min]비교,RF1.5조[(8.0±0.3)、(9.9±0.5) min]화RF2.0조[(8.2±0.3)、(10.1±0.4) min]차이무통계학의의,단RF2.5조[(8.3±0.5)、(11.6±0.7) min]명현연지,차이균유통계학의의(P＜0.05). 결론 RF지속파공수주가명현강저기관발관상관혈류동역학변화급창해반응,단수RF제량증가,마취소성시간연지.
Objective The trial was designed to examine the effects of target controlled infusion of remifentanil on recovery profiles such as cardiovascular responses and coughing after anaesthesia for thyroidectomy.Methods Eighty ASA Ⅰ or Ⅱ patients undergoing thyroidectomy surgery were randomly assigned to RF0.0 group,RF1.5 group,RF2.0 group,RF2.5 group.Each group contained 20 subjects.General anesthesia was maintained by total intravenous anesthesia (propofol and remifentanil).The target plasma concentrations of remifentanil were 0(RF0.0 group),1.5(RF1.5 group),2.0 (RF2.0 group),and 2.5 μg/L (RF2.5 group) during emergence from anesthesia.At the end of surgery,propofol was ceased.The infusion of remifentanil was stopped in RF0.0 group while maintained in the other 3 groups at a target plasma concentration of 1.5,2.0 μg/L or 2.5 μg/L till extubation.Heart rate (HR),mean arterial pressure (MAP),incidence and severity of coughing were recorded.Results The incidence and severity of coughing were lower in RF2.5 group and RF2.0 group compared with RF0.0 group(P＜0.05).MAP[(95±4),(87±4) mm Hg and(82±4) mm Hg (1 mm Hg=0.133 kPa)] and HR [(96.1±3.4),(85.2±3.0) and (79.9±2.4) bpm] values were significantly lower in the 3 groups rather than in RF0.0 group [MAP,(100±5) mm Hg and HR,(105±4) bpm] at the moment of tracheal extubation(P＜0.05).MAP [(100±3),(90±4) mm Hg and (86±4) mm Hg] and HR [(103±3),(92±3) bpm and (84±3) bpm] values were significantly lower in the 3 groups compared with the RF0.0 group [(100±5) mm Hg and(105±4) mm Hg] at 1 min after tracheal extubation(P＜0.05).MAP [(82.4±4.3) mm Hg and (85.7±4.0) mm Hg] and HR [(79.9±2.4) bpm and (84.4±3.3) bpm] values were significantly lower in RF2.5 group compared with RF1.5 group[(95±4) mm Hg and (100±3) mm Hg][(96.1±3.4) bpm and (103±3) bpm] or RF2.0 group [(87±4) mm Hg and (90±4) mm Hg] [(85.2±3.0) bpm and (92±3) bpm] at the moment or 1 min after tracheal extubation (P＜0.05).But time to eye opening and extubation were prolonged in RF2.5 group [(8.3±0.5) min and (11.6±0.7) min] compared with the RF0.0 group[(8.0±0.6) min and (9.8±0.5) min](P＜0.05).Conclusions Maintaining a remifentanil plasma concentration by TCI may reduce haemodynamic changes and incidence of coughing which associated with tracheal extubation in patients undergoing thyroidectomy.However,awakening may be delayed due to the relative higher remifentanil dose.
