不同剂量舒芬太尼对病人气管插管血流动力学的影响

目的比较不同剂量舒芬太尼复合异丙酚对病人气管插管血流动力学及脑电双频谱指数的影响,探讨舒芬太尼有效抑制气管插管应激反应的合适剂量。方法 60例择期全麻手术病人随机分为三组,每组20例,舒芬太尼剂量分别为0.2μg/kg（Ⅰ组）、0.3μg/kg（Ⅱ组）、0.4μg/kg（Ⅲ组）。3 min后三组均静脉注射异丙酚2 mg/kg和维库溴胺0.1 mg/kg麻醉诱导,经口气管内插管。记录麻醉诱导前（T0）、静脉注射舒芬太尼后（T1）、静脉注射异丙酚后（T2）、气管插管即刻（T3）、插管后3 min（T4）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脑电双频谱指数（BIS）的变化。结果与T0比较,T1时三组SBP、DBP、BIS比较差异无统计学意义（P〉0.05）,T2时三组SBP、DBP、BIS明显下降（P（0.05或P（0.01）,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;与Ⅱ组比较,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;三组间各时点HR比较差异无统计学意义。结论应用舒芬太尼0.3μg/kg复合异丙酚2 mg/kg麻醉诱导能有效抑制气管插管应激反应,并维持插管期间血流动力学稳定,是临床使用的合理剂量。

Effects of different dose of sufentanil on hemodynamics of patients with tracheal intubation

Objective To compare the effects of different dose of sufentanil on hemodynamics and bispectral index to tracheal intubation and to investigate proper dose of sufentanil which can effectively inhibit the stress reaction of tracheal intubation.Methods Sixty ASAⅠor Ⅱ patients undergoing selective operation under general anesthesia were randomly divided into three groups with 20 cases for each group.The dose of sufentanil were 0.2 μg/kg(group Ⅰ),0.3 μg/kg(group Ⅱ)and 0.4 μg/kg(group Ⅲ),respectively.Propofol 2 mg/kg and vecuronium 0.1 mg/kg were injected 3 minites after sufentanil and tracheal intubation was performed then after.SBP,DBP,HR,BIS were recorded immediately before induction of anesthesia(T0),after intravenous sufentanil injection(T1),after intravenous propofol injection(T2),immediately after intubation(T3)and at 3 min after intubation(T4).Results Compared to that before anesthesia,there were no significant differences in SBP,DBP,BIS at T1,but they were all decreased at T2 in the three groups(P<0.05 or P<0.01),SBP,DBP were significantly higher in group Ⅰat T3(P<0.05);SBP,DBP,BIS were higher in group Ⅰ than that in group Ⅱ at T3;While HR was not changed remarkably in the three groups during anesthesia induction.Conclusion Sufentanil 0.3 μg/kg combined with propofol 2 mg/kg for induction of anaesthesia can effectively depress the cardiovascular response to intubation,and causes less hemodynamic changes,which may be a rational dose clinically.