瑞芬太尼与芬太尼在小儿全麻诱导期的应用比较

目的：观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法：40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前（T0）、诱导后2min（T1）、插管后1、2min（T2、T3）记录心率、收缩压和舒张压。结果：两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低（P〈0.05或P〈0.01）,心率均减慢（P〈0.05或P〈0.01）;瑞芬太尼组T2、T3时收缩压、舒张压降低（P〈0.05或P〈0.01）,心率减慢（P〈0.05）;芬太尼组T2、T3时收缩压、舒张压升高（P〈0.05）,心率增快（P〈0.05）。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低（P〈0.05）,心率减慢（P〈0.05）。结论：瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。

Comparison of Remifentanil and Fentanyl during Induction of Pediatric Anaesthesia

Objective： To compare the effects of equivalent dose remifentanil （R） and fentanyl （F） on haemodynamics during induction of pediatric anaesthesia. Methods： Forty pediatric patients were randomly allocated to R group and F group. Anaesthesia was induced with midazolam 0.15 mg/kg, followed by propofol 2.5 mg/kg. Then remifentanil 2 μg/kg （R group） or fentanyl 2.5 μg/kg （F group） and vecuronium 0.1 mg/kg were given. Blood pressure and heart rate （HR） were recorded before induction, at 2 min after induction and 1, 2 min after tracheal intubation. Results： There was a significant reduction in systolic blood pressure （SBP） and diastolic blood pressure （DBP） before intubation compared to those before induction in two groups. Tracheal intubation was associated with a reduction in SBP, DBP and HR in R group. Tracheal intubation was associated with an increase in SBP, DBP and HR in F group. All differences had statistical significances （P〈0.05 or P〈0.01）. Conclusion： When used as part of anesthesia induction in children, remifentanil （2 μg/kg） is more effective in attenuating the cardiovascular intubation response than fentanyl （2.5 μg/kg）.