连续输注瑞芬太尼复合依托咪酯对老年患者气管插管血流动力学反应的影响

目的 观察全麻诱导期间连续输注瑞芬太尼复合依托咪酯对老年患者气管插管血流动力学反应的影响.方法 80例ASAⅠ～Ⅲ级老年患者随机分为A、B、C、D四组,每组20例.诱导开始时,A、B、C、D四组分别以0.3μg/（kg·min）、0.4 μg/（kg·min）、0.5 μg/（kg· min）、0.6 μg/（kg· min）的速度输注瑞芬太尼,2 min后静脉注射依托咪酯0.15 mg/kg,过1.5 min后静脉注射罗库溴铵0.6 mg/kg,再过1.5 min后行气管插管,同时调整所有患者瑞芬太尼的输注速度为0.05 μg/（kg· min）,并以4 μg/（kg·h）的速度输注异丙酚.记录诱导前（T0）、插管前即刻（T1）、插管后l min （T2）、插管后3min（T3）、插管后5 min（T4）的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）以及血管活性药物的使用情况.结果 A组T1MAP和HR与T0比较明显降低（P＜0.05）,T2、T3MAP和HR与T0比较明显升高（P＜0.05）;B、C组T1MAP和HR与T0比较明显降低（P＜0.05）,T2、T3、T4MAP和HR与T0比较差异无统计学意义（P＞0.05）;D组T1MAP和HR与T0比较明显降低（P＜0.05）,T2、T3MAP与T0比较明显降低（P＜0.05）;与D组比较,A、B、C组T1 MAP明显升高（P＜0.05）,A组T1HR明显升高（P＜0.05）;与A组和D组比较,B组和C组血管活性药物的使用率明显降低（P＜0.05）.结论全麻诱导期间连续输注瑞芬太尼5 min能够呈剂量依赖性地抑制老年患者气管插管的血流动力学反应,当复合依托咪酯为0.15 mg/kg时,瑞芬太尼输注速度以0.4～0.5 μg/（kgmin）为佳,血流动力学更稳定.

Effects of continuous intravenous infusion of remifentanil combined with etomidate on the haemodynamic responses to anesthetic induction and tracheal intubation in the elderly

Objective To investigate the effects of continuous intravenous infusion of remifentanil combined with etomidate on the haemodynamic responses during anesthetic induction and tracheal intubation in the elderly.Methods Eighty ASA Ⅰ～Ⅲ patients were randomly allocated to four groups,each with 20 patients：group A,B,C and D.Anaesthesia was induced with remifentanil 0.3 μg/（kg· min）,0.4 μg/（kg· min）,0.5 μg/（kg· min） or 0.6 μg/（kg·min） for group A,B,C and D,respectively.Then each patient was administered 0.15 mg/kg etomidate 2 min after the start of remifentanil infusion,and 0.6 mg/kg rocuronium 1.5 min after etomidate injection.Tracheal intubation was performed 1.5 min after rocuronium injection,and each patient was administered 0.05 μg/（kg· min） remifentanil and 4 μg/（kg· h） propofol at this time point.Noninvasive blood pressure and heart rate were recorded before anesthetic induction （T0）,immediately before intubation （T1）,1 min after intubation （T2）,3 min after intubation （T3）,and 5 min after intubation （T4）.The use of vasoactive agents was also recorded.Results Compared with T0,MAP and HR in group A decreased significantly at T1 （P〈0.05）,while those at T2,T3 increased significantly （P〈0.05）.Compared with T0,MAP and HR in group B and group C at T1 decreased significantly（P〈0.05）,while those at T2,T3,T4 showed no statistically significant difference （P〉0.05）.Compared with T0,MAP and HR in group D at T1 decreased significantly （P〈0.05）,and MAP at T2,T3 decreased significantly （P〈0.05）.Compared with group D,MAP in group A,B and C at T1 were significantly higher （P〈0.05）,and HR in group A was significantly higher （P〈0.05）.Compared with group A and group D,the use of vasoactive agents in group B and C were significantly lower （P〈0.05）.Conclusion Continuous intravenous infusion ofremifentanil for 5 min produces a dose-related attenuation of the haemodynamic response to tracheal intubation in the elderly,and remifentanil 0.4～0.5 μtg/（kg · min） combined with 0.15 mg/kg etomidate maintains more stable hemodynamics.