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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/m L;D组给予右美托咪定0.5μg/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。
Objective: To observe the effect of remifentanil and dexmedetomidine on the recovery period of general anesthesia in oral and maxillofacial surgery. Methods: Sixty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly divided into three groups: remifentanil group (R group), dexmedetomidine group (D group) and Control group (C group). At 10 min before the end of surgery, remifentanil was given in continuous infusion to remifentanil in group R at a mean plasma concentration of 1.5 ng / m L; in group D, dexmedetomidine was given at 0.5 μg / kg; and in group C, saline was given. The changes of hemodynamics, the Ramsay sedation score, the number of cough, the number of restlessness, the time of extubation and the incidence of adverse reactions were observed in the three groups. Data were statistically analyzed using SPSS 20.0 software package. Results: The heart rate and mean blood pressure were significantly lower in group R and group D than those in group C (P <0.05). The Ramsay scores of group R and group D at 5 and 10 min after extubation were significantly higher than those in group C (P <0.05). The number of people who coughed and agitated in group R and group D were significantly lower than those in group C (P <0.05). There was no significant difference in extubation time among the three groups. CONCLUSION: Both remifentanil and dexmedetomidine can significantly reduce the hemodynamic changes during anesthesia in patients undergoing oral and maxillofacial surgery, reduce cough and restlessness, and prolong the time of extubation. Dexmedetomidine provides remifentanil with a longer duration of sedation during wakefulness.