瑞芬太尼与芬太尼对抢救性气管插管应激反应的比较

目的观察瑞芬太尼与芬太尼静脉注射对降低抢救性气管插管应激反应的效果。方法60例需机械通气的急慢性呼吸衰竭患者,神志清楚或浅至中度昏迷状态,随机分成A、B两组（n=30）。A组使用1%丁卡因表面喷雾麻醉,瑞芬太尼1μg/kg、咪达唑仑0.15mg/kg静脉推注,再次表面麻醉后行气管插管;B组为对照组,使用芬太尼2μg/Kg、咪达唑仑0.15mg/kg静脉推注,其余步骤同A组,记录插管前和插管后1、3、5min SBP、DBP、HR、SpO2及恶心呕吐、屏气呛咳、口腔咽喉黏膜损伤例数。结果A组插管后SBP、DBP、HR升高明显小于B组（P〈0.01）;恶心呕吐、屏气呛咳、口腔咽喉黏膜损伤例数明显小于B组（P〈0.01）;30s内完成例数、SpO2改善高于B组（P〈0.01）。结论瑞芬太尼在降低抢救性气管插管应激反应的效果明显优于芬太尼。

The comparison of stressing response induced by tracheal intubation with remifentanil and fentanyl

Objective To observe the effect of fentanly and remifentanil on stessing response induced by tracheal intubation. Methods 60 cases with chronical respiratory failure needed to be mechanical ventilated were randomly divided into 2 groups. Topical anesthesia was applied with tetracaine,followed by remifentanil of 1 μg/kg and midazolam of 0. 15 mg/kg intravenously injection in A group. While fentanyl of 2 μg/kg instead of remifentanil was administered intravenously in B group,the other procedure was as the same as that of A group. SBP, DBP, HR, SpO2 was recorded befor tracheal intubation and at 1,3,5 minute after tracheal intubation. Nau- sea and vomitting,bucking,injury of membrana mucosa laryngis was also observed. Results SBP, DBP, HR were not increseaced dramatically in A group as compared with that of B group after iutubation. The number of nausea and vomitting,bucking,lnjury of menbrana mucosa laryngis in A group was lower than in B group. The number of patient performed intubation within 30 seconds was higher and SpO2 was improved significantly during intubation in A group. Conclusion Remifentanil was better than fentanyl in depressing stressing response induced by tracheal intubation.