瑞芬太尼在老年人无肌松药及小剂量肌松药诱导气管插管中的应用

目的：对比评价靶控输注瑞芬太尼用于老年人无肌松药及小剂量肌松药诱导气管插管的条件。方法：选择ASAⅠ～Ⅱ级行气管插管全麻的老年患者44例,随机分成两组,Ⅰ组为无肌松药组,Ⅱ组为肌松药（琥珀胆碱）组,以瑞芬太尼效应部位靶浓度3.5 ng/ml和丙泊酚效应部位靶浓度3μg/ml行靶控输注诱导后,Ⅰ组进行气管插管,Ⅱ组则静注琥珀胆碱0.4 mg/kg后插管。记录诱导前基础值、诱导后2 min及插管后1、3、5 min的血压（BP）、心率（HR）;插管时参照Erhan等的评价方法,对插管条件进行综合评价。结果：Ⅰ组插管满意率为81%,Ⅱ组插管满意率为95%。两组在麻醉诱导后2 min的BP、HR均明显下降（P〈0.05）;插管后1 min的BP、HR均升高,但与基础值无明显差异,插管后3、5 min的BP、HR很快趋于平稳,组间无显著性差异。结论：在老年患者靶控输注瑞芬太尼3.5 ng/ml和丙泊酚3μg/ml复合小剂量琥珀胆碱（0.4 mg/kg）麻醉诱导可提供满意的气管插管条件。

The application of Remifentanil in tracheal intubation of the aged patients by muscle relaxants-free and small dosage of muscle relaxants

Objective： To evaluate the conditions of target controlled infused Remifentanil in induction of tracheal intuba-tion of the aged patients by muscle relaxants-free or small dosage of muscle relaxants.Methods： 44 cases of ASAⅠ-Ⅱ aged patients who underwent general anesthesia by tracheal intubation were selected and divided into two groups.Group Ⅰ was muscle relaxant-free group,and group Ⅱ was muscle relaxant（chloride） group.After induction of target controlled in-fusion（TCI） with the target concentration of Remifentanil at effect site 3.5 ng/ml and that of propofol 3 μg/ml,tracheal in-tubation was done in group Ⅰ,however,tracheal intubation was done in group Ⅱ was done after intravenous injection of chloride at the dosage of 0.4 mg/kg.The basic value of BP and HR were noted down,so were the value of BP and HR after 2 min of induction,1 min after intubation,3 min after intubation and 5 min after intubation.The condition of intubation were synthesized and evaluated according to the evaluation method by Erhan etc.when intubation.Results： The satisfac-tion rate of intubation of group Ⅰ was 81% and that of group Ⅱ was 95%.BP and HR value in both of the two groups de-scent significantly at 2 min after induction of anesthesia（P〈0.05）.Both BP and HR value at 1 min after intubation ascent,but no significant difference with basic value.BP and HR tend to be stable very soon at 3 min and 5 min after intubation.No difference between the two groups.Conclusion： Target controlled infusion of Remifentanil at the target effect site con-centration of 3.5 ng/ml and that of propofol at 3 μg/ml combined with small dosage of chloride can provide satisfactory tra-cheal intubation conditions in aged patients.