不同输注速度瑞芬太尼对小儿心脏快通道麻醉应激反应的影响

目的观察不同输注速度瑞芬太尼对小儿心脏快通道麻醉血流动力学及应激反应的影响。方法24例择期房、室间隔缺损修补术患儿，随机分为两组：Ⅰ组、Ⅱ组（分别持续输入瑞芬太尼0．25μg·kg^-1·min^-1，0．50μg·kg^-1·min^-1）。记录患儿入睡（T0基础），气管插管（T1）、切皮（T2）、劈胸骨（T3）、开始转机（T4）、转机10min（T5）、复温5min（T6）、停机（T7）、停机10min（T8）、穿钢丝（T9）、手术结束（T10）和拔除气管插管（T11）、拔管后0．5h（T12），2h（T13）时血压、心率。T0，T3，T6，T12，T13抽取动脉血检测去甲肾上腺素（Noradrenaline NE）、皮质醇（Cortisol COR）血糖（Blood GlucoseBG）、乳酸浓度（Lacticacid LAC）。记录围术期血管活性、镇静、镇痛药物。结果所有患儿均在手术室内拔管，术中血流动力学稳定，拔管后心率明显增快，Ⅱ组还伴有血压升高，且术后应用降压及镇静药物显著多于1组。两组NE浓度在围术期无显著变化，Ⅱ组T12的NE浓度，T6、T13的COR、BG、LAC浓度均显著高于I组。结论两种输注速度的瑞芬太尼可有效阻断去甲肾上腺素的释放，但0．50μg·kg^-1·min^-1瑞芬太尼可以更好抑制皮质醇、血糖和乳酸的升高，拔管后循环更稳定。

Effect of remifentanil infusion rate on stress response in fast track paediatric cardiac anaesthesia

Objective To compare the effects of remifentanil infusion rate on hemedynamic indices and stress response in fast track paediatric cardiac anaesthesia. Methods 24 patients with atrial septal defect or simple ventricular septal defect were randomly assigned to group Ⅰ with 0.25 μg·kg^-1·min^-1 remifentanil and group Ⅱ with 0.50 μg·kg^-1·min^-1 remifentanil. Arterial pressure, heart rate. were recorded at conscious loss as baseline （T0）, post intubation （ T1 ）, skin incision （ T2）, sternotomy （ T3 ）, establish of CPB（T4）, 10rain ofCPB（TS）, 5 min after rewarmed （T6）, end of CPB（TT）, 10m/n after CPB （T8）, sternal wires （T9）, end of operation （T10） , extubation （ T11 ）, 0.5 and 2 hours after extubation （T12 and T13）. Serum norepinephrine（NE）, cortisol（COR）, glucose（BG）, lactate acid（LAC） levels were measured at T0, T3, T6, T12, T13. Periopemtive vasediolator, sedative and analgesia treatments were recorded. Results All the patients were successfully extubated in the OR. Heart rate increased in both groups after extubation while blood pressure only increased in group Ⅱ with more vasedilator and sedative treatments. Serum NE concentration was constant in both groups. COR, BG, LAC concentration in group Ⅱ were significantly higher than group Ⅰ at T6, T13. Conclusions Both infusion rate of remifentanil can supress the NE increase while 0.50 μg·kg^-1·min^-1. remifentanil can attenuate the increase of COR, BG, LAC and postoperative hypertension better.