胸椎旁神经阻滞复合术毕继续瑞芬太尼泵注对全麻患者术后双腔气管拔管不良反应的预防效果

发布时间：2019-06-04 14:13

【摘要】：目的观察气管插管后罗派卡因胸椎旁神经阻滞复合术毕继续瑞芬太尼泵注对全身麻醉(简称全麻)肺叶切除术患者术后双腔气管拔管不良反应的预防效果。方法全麻双腔气管插管下行开胸肺叶切除术的患者90例,随机分为对照组(C组)、瑞芬太尼低剂量组(R1组)、瑞芬太尼高剂量组(R2组),每组30例。所有患者在全麻双腔气管插管后、手术开始前,在超声引导下行罗派卡因胸椎旁神经阻滞。术中均给予丙泊酚、瑞芬太尼、罗库溴铵维持麻醉。开始缝合切口时,R1组、R2组分别继续泵注瑞芬太尼0.2、0.3μg/(kg·min),待患者清醒后停止泵注;C组泵注等量氯化钠注射液。记录拔管前及拔管时呛咳反应发生情况、拔管知晓情况、拔管舒适度、清醒时间、拔管时间。监测患者麻醉前、拔管前1 min、拔管即刻、拔管后2 min、拔管后5 min、拔管后10 min、拔管后15 min的BP、HR、RR、SpO_2。分别于拔管后5、10、20、30、60 min时进行视觉模拟疼痛评分(VAS),分别于拔管即刻和拔管后2、5、10、15 min时进行Riker镇静和躁动评分(SAS)。术后第二天随访,记录术中知晓情况及头痛、恶心呕吐、尿潴留、皮肤瘙痒的发生率。结果 C组、R1组、R2组呛咳反应、拔管知晓、拔管不适发生率依次降低,清醒时间、拔管时间依次延长(P均0.05)。与麻醉前相比,C组和R1组拔管前1 min、拔管即刻、拔管后2 min、拔管后5 min的收缩压、舒张压、HR都有所增加(P均0.05)。与麻醉前相比,RI组拔管前1 min、拔管即刻时RR有所下降(P均0.05)。与麻醉前相比,R2组拔管前1 min、拔管即刻、拔管后2 min、拔管后5 min的RR均有所下降(P均0.05)。R1组、R2组拔管后5 min时VAS低于C组(P均0.05)。R1组、R2组拔管即刻及拔管后2 min时SAS低于C组(P均0.05)。R2组恶心呕吐发生率高于C组(P0.05)。结论罗派卡因胸椎旁神经阻滞复合术毕继续瑞芬太尼泵注可减少全麻患者双腔气管拔管相关不良反应发生率,提高拔管舒适性,提供良好的术后镇痛;瑞芬太尼0.3μg/(kg·min)剂量应用效果优于0.2μg/(kg·min)剂量,但患者清醒时间和拔管时间会有所延长,也会导致部分患者RR减慢,需掌握好停全麻药的时机,并密切监测RR和SpO_2。
[Abstract]:Objective to observe the preventive effect of remifentanil pump on patients with double lumen extubation after endotracheal intubation. Methods 90 patients undergoing thoracotomy under general anesthesia and double lumen endotracheal intubation were randomly divided into control group (group C), remifentanil low dose group (R1 group) and remifentanil high dose group (R2 group) with 30 cases in each group. After general anesthesia and double lumen endotracheal intubation, ropivacaine thoracic paravertebrospinal nerve block was performed under the guidance of ultrasound before the operation began. Propofol, remifentanil and rocuronium were given during operation to maintain anesthesia. At the beginning of suture incision, remifentanil 0.2 渭 g / group and 0.3 渭 g / (kg 路min),) were injected with remifentanil 0.2 渭 g / (remifentanil 路min),) and equal dose sodium chloride injection respectively in group R1 and R2 respectively. The occurrence of cough before and during extubation, extubation knowledge, extubation comfort, awake time and extubation time were recorded. The BP,HR,RR,SpO_2. of patients was monitored before anesthesia, 1 min, before extubation, 2 min, after extubation, 5 min, after extubation, 10 min, after extubation, and 15 min after extubation. Visual simulated pain score (VAS), was performed at 5, 10, 20, 30 and 60 min after extubation, and Riker sedation and restlessness score (SAS). Was performed at 5, 10, 10, 15 min after extubation, respectively. Follow-up on the second day after operation was followed up to record the incidence of headache, nausea and vomiting, urinary retention and pruritus. Results in group C, R1 and R2, the cough reaction, extubation knowledge and extubation discomfort decreased in turn, and the awake time and extubation time were prolonged in turn (P 0.05). Compared with before anesthesia, the systolic blood pressure, diastolic blood pressure and HR in group C and R1 were increased at 1 min, before extubation and 5 min after extubation at 2 min after extubation (all P 0.05), and the systolic blood pressure (SBP), diastolic blood pressure (DBP) and diastolic blood pressure (HR) were increased in group C and R1 immediately before extubation. Compared with before anesthesia, RR decreased at 1 min, extubation in RI group. Compared with before anesthesia, the RR of group R2 was decreased at 1 min, before extubation and 5 min after extubation at 2 min after extubation. VAS in group R1 was lower than that in group C at 5 min after extubation. SAS in R2 group was lower than that in C group at 2 min after extubation, and the incidence of nausea and vomiting in R2 group was higher than that in C group (P 0.05). Conclusion continuous remifentanil infusion can reduce the incidence of adverse reactions related to double lumen extubation in patients with general anesthesia, improve the comfort of extubation and provide good postoperative analgesia. The effect of remifentanil 0.3 渭 g / (kg 路min) is better than that of 0.2 渭 g / (kg 路min), but the awake time and extubation time of the patients will be prolonged, which will also slow down the RR of some patients, so it is necessary to master the time of withdrawal of general anesthetics. And closely monitor RR and SpO_2..
【作者单位】：昆明医科大学第一附属医院;
【分类号】：R614.2

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