术毕持续泵注个体化小剂量瑞芬太尼对胸腔镜肺部分切除术患者苏醒期躁动的影响

Effect of continuous postoperative infusion of individual low-dose remifentanil on emergence agitation in patients undergoing video-assisted thoracoscopic partial pulmonary resection

中文关键词: 瑞芬太尼  苏醒期躁动  胸腔镜  肺叶切除术

英文关键词: Remifentanil  Emergence agitation  Video-assisted thoracoscopic surgery  Partial pulmonary resection

中文摘要:

      
目的：观察术毕持续泵注个体化小剂量瑞芬太尼对胸腔镜肺部分切除术患者苏醒期躁动的影响。
方法：选择择期行胸腔镜肺部分切除术患者120例，男56例，女64例，年龄18～80岁，BMI 18.5～30.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为四组：A组、B组、C组和D组，每组30例。A组、B组和C组术毕分别按照患者的基础速率（术毕前30 min的平均速率）的1/2、1/4、1/8持续泵注瑞芬太尼；D组术毕停止泵注瑞芬太尼，将生理盐水按基础速率的1/2持续泵注。四组均泵注至拔管后10 min。记录拔管后10 min的Riker镇静躁动评分（RSAS）。记录拔管时、拔管后5、10、15 min及术后6 h的VAS疼痛评分。记录拔管时呛咳发生情况、自主呼吸恢复及拔管时间。记录拔管时、拔管后5、10、15 min的HR和MAP。记录镇痛泵有效按压次数、术后消耗氟比洛芬酯例数以及术后需行肋间神经阻滞例数。
结果：与D组比较，A组、B组和C组拔管后10 min的RSAS评分、苏醒期躁动发生率、拔管后5、10、15 min的VAS疼痛评分、拔管时呛咳发生率均明显降低（P＜0.05），拔管时间均明显延长（P＜0.05），A组和C组拔管时VAS疼痛评分明显降低（P＜0.05），A组和B组自主呼吸恢复时间明显延长（P＜0.05），A组拔管后5、10、15 min的MAP和镇痛泵有效按压次数、需行肋间神经阻滞率明显降低（P＜0.05）。与C组比较，A组和B组拔管时间明显延长（P＜0.05）。与A组比较，B组和C组RSAS评分、拔管时、拔管后5、10 min VAS疼痛评分明显升高（P＜0.05）。
结论：术毕持续泵注个体化小剂量瑞芬太尼可以降低胸腔镜肺部分切除术患者全麻苏醒期躁动发生率，同时降低拔管时呛咳发生率，提高患者苏醒期舒适度，其中以术毕前30 min瑞芬太尼平均泵注速率的1/8维持效果最好。

英文摘要:

      
Objective: To observe the effect of continuous postoperative infusion of individual low-dose remifentanil on emergence agitation in patients undergoing video-assisted thoracoscopic partial pulmonary resection.
Methods: A total of 120 patients, 56 males and 64 females, aged 18-80 years, BMI 18.5-30.0 kg/m², with ASA physical status Ⅰ or Ⅱ, scheduled for elective video-assisted thoracoscopic partial lung resection were randomly assigned into four groups using a digital random table method: group A, group B, group C, and group D, 30 patients in each group. At the end of surgery, group A received remifentanil at half the basal rate, group B at one-quarter the basal rate, and group C at one-eighth the basal rate (basal rate: the average remifentanil infusion dose in the 30 minutes preceding the end of surgery). In group D, the pump infusion of remifentanil was stopped at the end of the operation, and normal saline was continuously infused at half of the basal rate. In all four groups, the pump infusion was continued until 10 minutes after extubation. The Riker sedation-agitation scale (RSAS) was recorded at 10 minutes after extubation. VAS pain scores were assessed at the time of extubation, 5, 10, 15 minutes after extubation, and 6 hours after surgery. MAP and HR were measured at the time of extubation, 5, 10, and 15 minutes after extubation. Incidence of cough during extubation, recovery of spontaneous breathing, and time to extubation were recorded. The effective compression on the postoperative analgesia pump, the number of flurbiprofen axetil usage, and the number of postoperative intercostal nerve blocks were also recorded.
Results: Compared with group D, the RSAS scores 10 minutes after extubation, the incidence of emergency agitation, the VAS pain scores 5, 10, and 15 minutes after extubation, and the incidence of coughing during extubation were significantly decreased in groups A, B, and C (P < 0.05), the extubation time was significantly longer in groups A, B, and C (P < 0.05), the VAS pain scores at extubation were significantly decreased in groups A and C (P < 0.05), the recovery time of spontaneous breathing was significantly longer in groups A and B (P < 0.05), the MAP 5, 10, and 15 minutes after extubation, the number of effective compression on the postoperative analgesia pump, and the rate of intercostal nerve block were significantly reduced in group A (P < 0.05). Compared with group C, the extubation time in groups A and B was significantly extended (P < 0.05). Compared with group A, the RSAS score, VAS pain score at the time of extubation, 5 and 10 minutes after extubation were significantly higher in groups B and C (P < 0.05).
Conclusion: Continuous pump infusion of individualized low-dose remifentanil at the end of surgery can reduce the incidence of emergence agitation in patients undergoing video-assisted thoracoscopic partial pulmonary resection. Meanwhile, it can also decrease the incidence of cough during extubation and improve patients' comfort during the emergence period. Among them, maintaining the infusion at 1/8 of the average pump infusion rate of remifentanil 30 minutes before the end of surgery is best.