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瑞芬太尼在治疗成人全麻术后急性躁动方面优于丙泊酚
贵州医科大学 麻醉与心脏电生理课题组
翻译：王贵龙 编辑：杨荣峰 审校：曹莹
急性躁动（EA）是成人全身麻醉恢复期最常见的并发症之一。瑞芬太尼和丙泊酚可降低EA的发生率，但目前尚无随机对照试验评估它们治疗EA的有效性。本研究旨在比较瑞芬太尼和丙泊酚治疗全麻术后EA的有效性。
本研究共纳入152名患者，平均49.5岁，其中99名（65.1%）为男性，最终149名患者被随机分为两组进行后续分析，瑞芬太尼组（R组，n = 74）在患者躁动发生后静脉输注瑞芬太尼0.5μg kg-1，随后以0.05μg kg-1 min-1的速率静脉输注至15 min。丙泊酚组（P组，n=75）在出现躁动时接受1mg/kg-1丙泊酚输注。使用Riker Sedation Agitation评分评估苏醒躁动，评分≥5定义苏醒期躁动。在PACU期间，评估了苏醒躁动的再发、拔管时间和PACU转出情况。
R组复再发躁动的发生率（29.7%）低于P组（49.3%），OR为0.44（95%CI 0.22-0.85；P=0.014）。与P组相比，R组的拔管时间更短（P<0.001），入住PACU的时间也更短（P=0.001）。
瑞芬太尼输注治疗在成人全麻术后急性躁动方面比丙泊酚更有效，拔管时间和PACU入住时间更短。
原始文献来源： Jun, Li; Hongrui, Zhu; Yu, Wang; Jiaqi, Chen; Keqiang, He; Sheng, Wang；Remifentanil is Superior to Propofol for Treating Emergence Agitation in Adults After General Anesthesia；Drug Des Devel Ther 2024;18(0):341-350；PMID：38344258
Remifentanil is Superior to Propofol for Treating Emergence Agitationin Adults After General Anesthesia
Abstract
BACKGROUND: Emergence agitation (EA) is one of the most common complications in clinical general anesthesia during recovery in adults. Remifentanil and propofol can reduce the incidence of EA, but with no randomized controlled trial to evaluate their effectiveness for treating EA. This study aims to compare the effectiveness of remifentanil and propofol for treating EA following general anesthesia.
PATIENTS AND METHODS: Among 152 randomized patients with a mean of 49.5 years, and 99 (65.1%) of them being male, 149 were divided into two groups for subsequent analysis. The remifentanil group (Group R, n = 74) received a 0.5μg kg-1 remifentanil infusion followed by a 0.05μg kg-1 min-1 infusion until 15 minutes, after the onset of agitation. The propofol group (Group P, n = 75) received a 1mg kg-1 propofol infusion once agitation occurred. Emergence agitation was assessed using the Riker Sedation Agitation Score, with a score of ≥5 defining emergence agitation. During the post-anesthesia care unit (PACU), the recurrence of emergence agitation, time to extubation, and discharge from PACU were evaluated.
RESULTS: The incidence of reoccurring emergence agitation was lower in Group R (29.7%) compared with Group P (49.3%), with an odds ratio of 0.44 (95% CI 0.22-0.85; P=0.014). The time to extubation was shorter in Group R (mean 12min, range 8-15 min) compared with Group P (mean 17min, range 13-21 min) (P<0.001), as was the time discharge from the PACU (mean 30.5 min, range 25-40 min) vs Group P (mean 37.5 min, range 31-50 min) (P=0.001).
CONCLUSION: Treatment of emergence agitation in adults with remifentanil infusion is more effective than propofol, with a shorter time to extubation and discharge from PACU.
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