雷米芬太尼对老年患者气管插管心血管反应的影响

目的观察不同剂量雷米芬太尼微量泵输注对老年患者气管插管时的心血管反应。方法 60例全麻老年患者随机均分为六组。泵注丙泊酚33 mg/min至意识消失后,Ⅰ、Ⅱ、Ⅲ组分别输注雷米芬太尼0.15、0.20、0.25μg.kg-1.min-1,持续6 min;Ⅳ、Ⅴ、Ⅵ组分别输注雷米芬太尼0.15、0.20、0.25μg.kg-1.min-1,持续8 min。丙泊酚维持量0.12 mg.kg-1.min-1。雷米芬太尼输注结束时静注罗库溴铵0.6 mg/kg,气管插管。记录诱导前(T0)、气管插管前1 min(T1)、气管插管后1 min(T2)、2 min(T3)、3 min(T4)、4 min(T5)、5 min(T6)的SBP、DBP和HR变化。结果与T0时比较,T1时六组SBP、DBP明显下降、HR明显减慢(P0.05或P0.01),T2和T4时Ⅲ、Ⅴ、Ⅵ组HR均明显减慢(P0.05或P0.01)。与T1时比较,T2~T3时Ⅰ、Ⅱ组SBP和DBP、T2~T4时Ⅳ组SBP均明显升高(P0.05或P0.01);Ⅰ、Ⅳ、Ⅴ组T2~T6时、Ⅱ组T2~T3时、Ⅲ组T3~T6时和Ⅵ组T3~T5时的HR明显增快(P0.05或P0.01)。结论老年患者气管插管时,雷米芬太尼复合丙泊酚微量泵输注时,雷米芬太尼以0.20或0.25μg.kg-1.min-1的速度,泵注6 min以上可以有效地抑制气管插管时的心血管反应。     

不同靶浓度雷米芬太尼对全麻苏醒拔管期心血管反应的影响

目的观察全麻苏醒拔管期不同靶浓度雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行胆囊手术患者40例,ASAⅠ或Ⅱ级,随机均分为四组:雷米芬太尼血浆靶浓度0.6μg/L组(Ⅰ组)、0.8μg/L(Ⅱ组)、1.0μg/L(Ⅲ组)和生理盐水对照组(Ⅳ组)。四组患者均接受丙泊酚、阿曲库铵、芬太尼、1%~2.5%异氟醚复合50%氧化亚氮的全身麻醉。术毕,Ⅰ、Ⅱ、Ⅲ组患者均TCI输注雷米芬太尼,血浆浓度分别为0.6、0.8、1.0μg/L,Ⅳ组TCI输注生理盐水作对照。观察TCI开始前、吸氮时、拔管时、拔管后5、10min的MAP和HR;观察TCI开始后的患者呼吸恢复时间、睁眼时间、拔管时间。结果Ⅰ、Ⅳ组的MAP和HR在吸痰、拔管时较TCI开始前明显升高(P<0.05),Ⅱ、Ⅲ组无明显升高;四组呼吸恢复时间、睁眼时间、拔管时间差异无统计学意义。结论雷米芬太尼用于抑制全麻苏醒拔管期心血管反应的合适血浆浓度可能在0.8~1.0μg/L之间。     

全麻苏醒拔管期雷米芬太尼靶控输注对心血管反应的影响

目的观察全麻苏醒拔管期雷米芬太尼靶控输注(TCI)对心血管反应的影响。方法择期行妇科手术患者60例,ASAⅠ~Ⅱ级,随机均分为雷米芬太尼组(A组)和生理盐水对照组(B组)。两组患者均接受丙泊酚、维库溴铵、芬太尼、0·8%~1·0%异氟醚复合50%氧化亚氮的全身麻醉。术毕时送至麻醉复苏室(PACU),A组患者TCI输注雷米芬太尼,血浆浓度为1μg/L,B组TCI输注生理盐水作对照。观察苏醒期患者的平均动脉压(MAP)、HR、呼吸恢复时间、睁眼时间和拔管时间。结果A组患者在吸痰、拔管时MAP、HR无明显变化,B组则明显升高(P<0·05);两组患者呼吸恢复、睁眼、拔管时间差异无显著意义。结论TCI雷米芬太尼可抑制全麻苏醒拔管期的心血管反应,平稳苏醒。     

雷米芬太尼对围拔管期心血管反应的影响

全麻苏醒期气管拔管,可引起患者血压升高和心率增快等不良心血管反应,严重者会导致心律失常、心肌缺血的加重和脑血管意外。雷米芬太尼常用于抑制气管插管时心血管反应[1,2],但用于气管拔管报道甚少,本研究观察其在围拔管期对心血管反应的影响。资料与方法一般资料择期行腹部手     

雷米芬太尼靶控输注抑制全麻拔管期心血管不良反应的剂量探讨

目的探讨雷米芬太尼靶控输注(TCI)拔管期有效抑制心血管反应的半数有效血浆浓度(EC50)。方法择期全麻下行腹腔镜胆囊切除术(LC)成人患者40例,按照序贯法TCI血浆浓度分别为0.6、0.8、1.0、1.2和1.4 ng/ml的雷米芬太尼,初始靶浓度为1.0 ng/ml,若患者拔管时SBP高于基础值的20%或HR快于100次/分,或拔管时出现呛咳、躁动,则下一例患者采用高一级浓度的雷米芬太尼TCI;反之则采用低一级浓度的雷米芬太尼TCI。计算全麻拔管期有效抑制心血管反应的雷米芬太尼EC50及其95%可信区间(CI)。结果TCI雷米芬太尼抑制心血管反应的EC50为1.03 ng/ml,其95%CI为0.97~1.09 ng/ml。结论LC全麻拔管期有效抑制心血管反应的雷米芬太尼EC50为1.03 ng/ml。     

雷米芬太尼不同给药方式抑制气管插管心血管反应的临床观察

麻醉诱导时喉镜置入和气管插管引起的交感神经兴奋可导致血压升高和心动过速，严重者会导致心律失常和心肌缺血的加重。常见的预防插管反应的方法包括静脉使用阿片类药物、钙离子拮抗药、β受体阻断药等。本研究旨在观察雷米芬太尼靶控注射对气管插管心血管反应的影响。     

异氟醚麻醉下雷米芬太尼抑制切皮心血管反应的最低血浆有效浓度

目的测定雷米芬太尼抑制切皮刺激心血管反应(心率增快和血压升高不超过基础值20%)的最低血浆有效浓度(MPCBAR)。方法40例妇科择期开腹手术患者均分为两组,呼气末异氟醚浓度分别维持在0.5MAC(Iso0.5组)和1.0MAC(Iso1.0组),并稳定15min以上。气管插管后两组按预设浓度TCI雷米芬太尼,以切皮刺激反应和血流动力学变化为指标,采用序贯法测定两组雷米芬太尼的MPCBAR。结果Iso0.5组雷米芬太尼MPCBAR为(3.33±0.38)ng/ml,95%可信区间为2.94～3.73ng/ml;Iso1.0组雷米芬太尼MPCBAR为(2.17±0.74)ng/ml,95%可信区间为1.39～2.94ng/ml。结论维持较高的呼气末异氟醚浓度能有效降低雷米芬太尼抑制妇科手术切皮刺激心血管反应的MPCBAR。     

不同雷米芬太尼血浆靶控浓度实施气管插管的条件和心血管反应

目的研究不同雷米芬太尼血浆靶控浓度复合丙泊酚输注在不使用肌松药时的气管插管条件和心血管反应。方法36例择期手术病人,随机分为三组,分别为雷米芬太尼血浆靶控浓度2ng/ml组、3ng/ml组和4ng/ml组。靶控输注(TCI)5min后,开始TCI丙泊酚(3μg/ml),10min后进行气管插管。失败病人则增加雷米芬太尼靶控浓度1ng/ml,10min后重复。分别在雷米芬太尼输注前、丙泊酚开始输注时、置入喉镜前即刻、插管后1min,记录气管插管评分、MAP、HR,同时记录不良反应和血管活性药物的使用情况。结果2ng/ml组、3ng/ml组及4ng/ml组第1次插管评分分别为(10.58±2.42)、(9.25±3.46)和(6.08±0.99)分;第1次插管成功率分别为6/12(50%)、7/12(58%)、10/12(83%);第2次插管成功率分别为1/6(17%)、2/5(40%)、1/2(50%)。三组雷米芬太尼输注后MAP无明显变化,HR均有下降,4ng/ml组尤其明显。2ng/ml组病人插管后与插管前相比HR与MAP有明显升高。高浓度雷米芬太尼组需用血管活性药物比例增加。结论固定丙泊酚TCI血浆浓度3μg/ml,不使用肌松药时,雷米芬太尼4ng/ml血浆浓度可基本满足插管条件。     

芬太尼影响琥珀胆碱心血管反应的研究

重复注射琥珀胆碱可引起严重心动过缓和心搏停止。近年来发现单次注射后也有发生,并认为可能与芬太尼的合并使用有关。本文研究芬太尼对琥珀胆碱心血管反应的影响。资料与方法一般资料:选20～60岁拟行择期手术的病人40例,术前一般情况均良好,无心血管系统疾患,心电图正常。随机分为加用芬太尼的实验组和未用芬太尼的对照组两组,每组20例,男女各半。实验组年龄为34.85±8.68岁,对照     

不同剂量雷米芬太尼对气管插管反应的影响

目的 观察不同剂量雷米芬太尼用于全麻诱导气管插管时的心血管反应,探讨其最佳的全麻诱导剂量.方法 将96例择期行腹部手术的患者随机均分为四组.全麻诱导均采用咪唑安定0.06 mg/kg、依托咪酯0.3 mg/kg、维库溴铵0.1 mg/kg;雷米芬太尼剂量分别为1μ9/kg(R1组)、2μg/kg(R2组)、3μ9/kg(R4组)和4μg/kg(R4组).记录诱导前(T0)、诱导后气管插管前(T1)、气管插管后即刻(T2)、气管插管后1min(T3)、2min(T4)、3min(T5)、5min(T6)和10min(T7)的SBP、DBP、HR的变化.结果 与T0比较,各组T1时SBP、DBP均明显下降(P<0.05或P<0.01),R1组T2、T3时SBP显著升高(P<0.05).与T0比较,各组患者T1时的HR均明显减慢(P<0.01),R1组患者T2、T3时HR显著增快(P<0.05或P<0.01).R2、R3组气管插管期间血压波动幅度均较R1、R4组小(P<0.05).结论 采用2～3μg/kg的雷米芬太尼麻醉诱导可有效抑制气管插管时的心血管反应.     

Use of lignocaine or nitroglycerine for blunting of hemodynamic stress response during electroconvulsive therapy

Background and aim of studyElectroconvulsive therapy (ECT) is one of the safest methods used for the treatment of patients with mental illness today. It is associated with surge in heart rate and blood pressure for a brief period of time. However, as an extreme complication, the hemodynamic response to ECT can produce myocardial ischaemia and even infarction, as well as transient neurological ischaemic deficits, intracerebral haemorrhages, and cortical blindness. This study is aimed towards finding a reliable drug that can prevent this untoward hemodynamic response in immediate post-ECT period.Place and duration of studyThe study was conducted at Combined Military Hospital Skardu after permission from the hospital ethics committee from January 2011 to December 2011.Study designOne thirty-four American society of Anaesthesiology (ASA) I & II patients of both genders were divided randomly in three groups named A, B and C. Patients were induced short general anaesthesia as per set protocol. Group A patients were given no additional drug, while group B patients had lignocaine 1 mg/kg and group C patients nitroglycerine (NTG) 3 μ/kg respectively just after induction. Heart rate (HR) and mean arterial pressure (MAP) were recorded 2 min after induction of anaesthesia just prior to ECT shock and then 1 min after ECT administration.Operation definitionsSignificant rise in heart rate was defined as an increase in heart rate of 10 or more beats per minute after administration of ECT shock from baseline.Significant rise in MAP was defined as the rise in MAP of 15 mm of Hg or more from the baseline after administration of ECT shock.ResultsThirty-three (75%) of 44 patients in group A showed significant rise in HR as compared to group B where no patient showed a significant increase in HR (p < .05). In terms of MAP 29 (65%) out of 44 patients showed a significant rise in group A and 22 (52%) out of 42 patients in group B showed similar results showing statically insignificant difference between the groups. When comparing patients of groups A and C, only 11 (22%) out of 48 patients showed significant rise in HR and 13 (27%) patients showed significant rise in MAP. The difference was statistically significant in both variables (p < .05).ConclusionNTG provided more hemodynamic stability in post-ECT period as compared to lignocaine which only prevented a surge in HR without any effect on MAP. We conclude that NTG can safely be instituted for anaesthesia in ECT patients for prevention of hemodynamic stress response.     

Effects of landiolol on hemodynamic response and seizure duration during electroconvulsive therapy

Purpose This study was done to evaluate the effect of landiolol, an ultra-short-acting beta-blocker, on the hemodynamic response and the duration of seizure activity during electroconvulsive therapy (ECT). Methods We designed a prospective, randomized, double-blinded, placebo-controlled, crossover study. Fourteen psychiatric patients participated. Landiolol (0.1 mg·kg⁻¹ or 0.2 mg·kg⁻¹) or saline (placebo) was administered IV 1 min before the induction of anesthesia. Unconsciousness was induced with propofol 1.0 mg·kg⁻¹ IV, and muscle paralysis was produced with succinylcholine 0.6 mg·kg⁻¹ IV. Subsequently, electrical stimulus was administered to elicit a seizure, and the duration of the motor seizure activity was noted. Results The heart rate (HR) and rate-pressure product (RPP) before ECT were significantly decreased in the 0.2 mg·kg⁻¹ landiolol group compared with these parameters in the placebo and 0.1 mg·kg⁻¹ landiolol groups. Both the 0.1 mg·kg⁻¹ and 0.2 mg·kg⁻¹ doses significantly attenuated the degree of tachycardia and RPP after ECT in comparison with the placebo group. Pretreatment with 0.2 mg·kg⁻¹ landiolol resulted in a significantly shorter duration of motor seizure than that in the placebo group (21 ± 13 s vs 27 ± 12 s). Conclusion As the landiolol dose of 0.2 mg·kg⁻¹ caused shorter seizure duration, and because the hemodynamic effects after ECT of the 0.1 mg·kg⁻¹ and 0.2 mg·kg⁻¹ doses were similar, it was concluded that a 0.1 mg·kg⁻¹ landiolol bolus was the appropriate dose pretreatment before ECT.     

瑞芬太尼对心血管系统的影响及其机制研究现状

瑞芬太尼作为一种新型超短效的阿片类镇痛药已经被广泛应用于临床,其可能造成的心率减慢、血压降低等心血管系统抑制作用也备受关注.现就瑞芬太尼对不同年龄患者心血管系统的影响及相关机制的研究进展进行分析探讨.     

Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy

BACKGROUND: The object of this study was to test whether substituting part of the methohexital dose with the short-acting opioid remifentanil would prolong seizure duration in middle-aged patients while providing a similar depth of anesthesia as with methohexital alone. This has been reported for the combined use of methohexital and remifentanil in elderly patients, but has not been investigated in middle-aged patients likely to require a higher total dose of methohexital for inducing anesthesia. METHOD: Seven patients (42+/-10 years; mean +/-SD) receiving electroconvulsive therapy (ECT) were anesthetized with methohexital (1.25 mg kg-1) or with methohexital (0.625 mg kg-1) plus remifentanil (1 micro g kg-1) in this randomized, double blind, crossover study. Additional methohexital was given as needed until loss of eyelash reflex was observed. Suxamethonium (1 mg kg-1) was used for muscular paralysis. RESULTS: Motor and EEG seizure durations were significantly longer after induction with methohexital plus remifentanil (45+/-14 and 58+/-15 s) than with methohexital alone (31+/-11 and 42+/-18 s). A methohexital dose of 1.2+/-0.3 and 1.9+/-0.3 mg was necessary to achieve loss of eyelash reflex if methohexital was used with and without remifentanil. Peak heart rate after ECT was significantly higher if remifentanil was coadministered with methohexital (148+/-12 vs. 126+/-24 b.p.m). CONCLUSION: Substituting part of the methohexital dose with remifentanil is a useful anesthetic technique to prolong seizure duration in middle-aged patients requiring a 1.5-fold higher induction dose of methohexital than elderly patients, the only population studied to date for the combined use of methohexital and remifentanil in ECT.     

预注右美托咪定对无抽搐电休克治疗中应激反应和肌痛的影响

目的观察在常规行无抽搐电休克治疗(modified electroconvulsive therapy,MECT)前预注三种剂量右美托咪定对患者应激反应和肌痛的影响。方法选择精神分裂症、抑郁症或躁狂症病程中首次行MECT的患者79例,男38例,女41例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为四组。分别在常规MECT前静脉匀速泵注右美托咪定0.4μg/kg(D1组,n=20)、0.7μg/kg(D2组,n=19)、1.0μg/kg(D3组,n=20)和等容量生理盐水20 ml(N组,n=20),四组均在10 min内泵完,随即行常规MECT。记录麻醉前(T0)、泵药(右美托咪定或生理盐水)10 min后(T_1)、MECT通电后30 s(T_2)及通电后5 min(T_3)的MAP和HR;记录T0、T_2时血糖和血皮质醇(Cor)浓度;记录通电后30min(T_4)和通电后6 h(T_5)的肌痛视觉模拟评分(VAS),以及苏醒时间和自主呼吸恢复时间。结果与N组比较,T_2时D1、D2、D3组Cor浓度、MAP明显降低,HR明显减慢,D2、D3组血糖浓度明显降低,且降低、减慢幅度D3组大于D2组,D2组大于D1组(P0.05);T_5时D1、D2、D3组肌痛VAS评分明显下降(P0.05);D2、D3组苏醒时间明显延长,且下降、延长程度D3组大于D2组,D2组大于D1组(P0.05)。四组自主呼吸恢复时间差异无统计学意义。结论 MECT治疗前预注右美托咪定,可剂量相关地减轻患者的应激反应和治疗后肌痛,延长苏醒时间。