右美托咪定和瑞芬太尼用于显微手术后拔管反应的观察.pdf

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1、CHINARCHOTOLARYNGOLHEADNECKSURG／April2014，Vo1．21，No．4213右美托咪定和瑞芬太尼用于显微手术后拔管反应的观察范雪梅一，王平-，叶京英2，李天佐-首都医科大学附属北京同仁医院1麻醉科，2耳鼻咽喉头颈外科，耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)，北京100730[摘要】目的观察右美托咪定和瑞芬太尼对喉显微dexmedetomidineandremifentanflonairwayresponsiveness，手术全麻苏醒期呛咳反应及血流动力学影响。方法选择bloOdpressur

2、eandheartrateduringextubationafter全麻喉显微手术9O例，随机分为D组(右美托眯定组)、Rmicrolaryngosurgery．METHODSNinetycasesundergoing组(瑞芬太尼组)和C组(对照组)，每_~f130例。于术毕前，Dmicrolaryngosurgerywererandomlydividedintothree组、c组停止瑞芬太尼输注，给予右美托1~0．4~g／kg或生groups．There、vereiMdexmedetomidinegroup(Dgroup)，理盐水，R

3、组调整瑞芬太尼靶浓度为2ng／ml,直至气管拔remifentanilgroup(Targetcontrolledinfusion，Rgroup)管。记录围拔管期呛咳的发生率及严重程度，血流动力学变orsalinegroup(Cgroup)．AttheendofSHrgcry,propofol化和苏醒期各项恢复指标及副反应。结果D组、R组呛咳wasstopped，andtheremifentanilinfusion．wasstopped发生率及严重程度低于c组。苏醒期不同时间点D组、R组ingroupDandC,maintainedin

4、groupRataneffect-site平均动脉压和心率低于c组，R组5例拔管后出现呼吸减慢concentrationof2．0ng／mluntilextubation．Atthesame或呼吸暂停。结论喉显微手术结束前静脉输注小剂量右time，dexmedetomidine0．4／kgorsaline0+15ml／kgwere美托咪定或低浓度瑞芬太尼，可明显减少气管拔管引起的intravenousinjectedingroupDandgroupC：respectively．气道和血流动力学应激反应，与后者相比，右美托咪定不影Thei

5、ncidenceandseverityofcough，haemodynamic响拔管后呼吸功能的恢复，更为安全有效。parameters，andrecoveryprofileswereevaluatedduring【关键词】右美托咪定；显微外科手术；麻醉，静脉；瑞芬recoveryperiod．RESULTSTheincidenceandseverityof太尼；气管拔管coughduringtherecoveryperiodwassignificantlyhigheringroupCthanthatingroupDandR．Theme

6、anarterialInfluenceofdexmedetomidineandremifentanilonpressureandheartrateweresignificantlylowerinthegroupextubationinducedairwayandcirculationresponsivenessDandgroupRthanthatingroupCduringtheemergence．aftermicrolaryngosurgeryperiod．Respiratorydepressionratewashigheringro

7、upFANXuemeiI，WANGPingJ,YEJingyings,L1TianzuoRthanthatingroupDandgroupC．CoNCLUSIoNI-vlDepartmentofAnesthesiOlOgy，2DepartmentOfdexmedetomidineandTCIofremifentanilbeforetheendOtolaryngologyHeadandNeckSurgery,BeijingTongrenofmicrolaryngosurgerycanreducetherespOnsiVenessHospi

8、tal，CapitalMedicalUniversity,KeyLaboratoryoftOextubationduringemergence．Giving0．4~g／kgOtolaryngologyHea