瑞芬太尼与右美托咪啶对口腔颌面外科全麻苏醒期的影响

上海口腔医学 ›› 2016, Vol. 25 ›› Issue (1): 101-104.

瑞芬太尼与右美托咪啶对口腔颌面外科全麻苏醒期的影响

陈佳伟，吕翔，张凌，陈志峰

上海交通大学医学院附属第九人民医院麻醉科，上海 200011

收稿日期:2015-01-07 修回日期:2015-05-26 出版日期:2016-02-25 发布日期:2016-03-09
通讯作者: 陈志峰，Tel：021-23271699-5170，E-mail：dzfc2013@163.com E-mail:chenjw11172@163.net
作者简介:陈佳伟（1988-），男，硕士，住院医师

Effects of remifentanil and dexmedetomidine on recovery profiles after oral and maxillofacial surgery

CHEN Jia-wei, LV Xiang, ZHANG Lin, CHEN Zhi-feng.

Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2015-01-07 Revised:2015-05-26 Online:2016-02-25 Published:2016-03-09

摘要/Abstract

摘要： 目的： 观察瑞芬太尼与右美托咪啶对口腔颌面外科全麻苏醒期的影响。方法： 口腔颌面外科全麻手术患者60例，性别不限，年龄18~65岁，随机分为3组：瑞芬太尼组（R组）、右美托咪定组（D组）和对照组（C组）。在手术结束10 min前，R组予以持续TCI输注瑞芬太尼，血浆浓度为1.5 ng/mL；D组给予右美托咪定0.5 μg/kg；C组给予生理盐水。观察3组患者苏醒期间血流动力学变化、Ramsay镇静评分、呛咳人数、躁动人数、拔管时间和不良反应的发生率。使用SPSS 20.0软件包对数据进行统计学分析。结果： R组和D组心率、平均血压在拔管时显著低于C组（P<0.05）；R组和D组Ramsay评分在拔管后5、10min显著高于C组，且D组显著高于R组（P<0.05）；R组和D组发生呛咳和躁动的人数均显著低于C组（P<0.05），3组患者拔管时间无显著差异。结论： 瑞芬太尼和右美托咪定均可明显减轻口腔颌面外科全麻患者苏醒期血流动力学变化，减少呛咳和躁动，不延长拔管时间。右美托咪定较瑞芬太尼在苏醒期间能提供更长时间的镇静作用。

关键词: 瑞芬太尼, 右美托咪定, 全麻苏醒期, 口腔颌面手术

Abstract: PURPOSE: To investigate the effects of remifentanil and dexmedetomidine on recovery period after oral and maxillofacial surgery. METHODS： Sixty cases undergoing oral and maxillofacial surgery were randomly divided into 3 groups, including remifentanil group (group R), dexmedetomidine group (group D) and normal saline group (group C). Ten minutes before the end of surgery, the patients were given target control infusion of remifentanil at effect-site concentration of 1.5 ng/mL in group R or dexmedetomidine 0.5 μg/kg in group D or normal saline in group C, respectively. The haemodynamic parameters, Ramsay scales, coughing, agitation were recorded. Extubation time and incidence of adverse events were observed as well. Statistical analysis was performed using SPSS20.0 software package. RESULTS: The mean arterial pressure and heart rate at the time of extubation were significantly lower in group D and group R than those in group C (P<0.05). The Ramsay scores were significantly better in group D and group R than in group C at the time point of 5 minutes and 10 minutes after extubation , and the score in group D was better than in group R at the same time (P<0.05). The incidences of coughing and agitation were significantly lower in group D and group R than in group C (P<0.05). There was no significant difference in extubation time. CONCLUSIONS: Dexmedetomidine and remifentanil can reduce the haemodynamic responsiveness, coughing and agitation during the recovery period of oral and maxillofacial surgery without extending the extubation time. Dexmedetomidine can provide longer sedation time than TCI of remifentanil.

Key words: Remifentanil, Dexmedetomidine, Anesthesia recovery period, Oral and maxillofacial surgery

中图分类号:

R782.05.4

陈佳伟，吕翔，张凌，陈志峰. 瑞芬太尼与右美托咪啶对口腔颌面外科全麻苏醒期的影响[J]. 上海口腔医学, 2016, 25(1): 101-104.

CHEN Jia-wei, LV Xiang, ZHANG Lin, CHEN Zhi-feng.. Effects of remifentanil and dexmedetomidine on recovery profiles after oral and maxillofacial surgery[J]. Shanghai Journal of Stomatology, 2016, 25(1): 101-104.

参考文献

[1] Mahoori A, Noroozinia H, Hasani E, et al. The effect of low-dose remifentanil on the hemodynamic responses of endotracheal extubation [J]. Acta Med Iran, 2014, 52(11): 844-847.
[2] Aouad MT, Al-Alami AA, Nasr VG, et al. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia[J]. Anesth Analg, 2009,108(4): 1157-1160.
[3] Turan G, Ozgultekin A, Turan C, et al. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery [J]. Eur J Anaesthesiol, 2008, 25(10): 816-820.
[4] 仇琳, 严伟民, 姜虹. 右美托咪定用于困难气道患者苏醒期拔管时的镇静效果[J]. 中国口腔颌面外科杂志,2011,9(1): 51-55.
[5] Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia [J]. Anesth Analg, 2004,99(4): 1253-1257.
[6] Cavaliere F, Antonelli M, Arcangeli A, et al. A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients [J]. Can J Anaesth, 2002, 49(10): 1088-1094.
[7] Popat M, Mitchell V, Dravid R, et al. Difficult Airway Society Guidelines for the management of tracheal extubation [J]. Anaesthesia, 2012,67(3): 318-340.
[8] 宁慧杰,陈巍,李永华,等.靶控输注瑞芬太尼抑制气管拔管期呛咳反应的临床研究 [J]. 临床麻醉学杂志, 2012, 28(7): 669-671.
[9] Nho JS, Lee SY, Kang JM, et al. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation [J]. Br J Anaesth, 2009, 103(6): 817-821.
[10] 陈志峰, 陈源昆, 郭勇, 等. 右美托咪啶对口腔颌面手术苏醒期躁动的作用评价 [J]. 上海口腔医学, 2013, 22(6): 698-701.
[11] 方宁宁, 侯跃东, 于金贵. 不同剂量右美托咪啶对甲状腺手术患者全身麻醉拔管期心血管反应的影响[J]. 山东医药, 2012, 52(38): 58-60.