雷米芬太尼对全麻患者气管插管期平均动脉压、心率和QTc间期延长的影响

目的 观察和评价雷米芬太尼对全麻患者气管插管期平均动脉压(MAP)、心率和QTc间期的影响.方法 选取择期全麻手术患者75例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为三组:对照组(C组)、雷米芬太尼Ⅰ组(R1组)和雷米芬太尼Ⅱ组(R2组),每组25例.麻醉诱导:静脉注射芬太尼3μg/kg、普鲁泊福1.0～1.5 mg/kg和维库溴铵0.1 mg/kg后2 min,双盲法≥40 s给予雷米芬太尼0.50 μg/kg(R1组)或0.75μg/kg(R2组)后,两组分别连续输注雷米芬太尼0.10μg/(kg·min);C组患者给予相同容量的0.9%氯化钠.记录麻醉诱导前(T0)、诱导后2 min(T1)、首次给予雷米芬太尼或0.9%氯化钠后1 min(T2)、气管插管前即刻(T3)及气管插管后30 s(T4)、2 min(T5)和4 min(T6)的MAP和心率,并描记心电图.结果 与C组比较,R2组T4～T6时QTc间期明显缩短(P＜0.05或＜0.01＝;R,组T4和C组T4～T6时QTc间期较T0明显延长(P＜0.05或＜0.01).C组气管插管期OTc间期＞440ms 11例(44%,11/25),R2组3例(12%,3/25),两组比较差异有统计学意义(P＜0.05).结论 芬太尼和普鲁泊福麻醉诱导气管插管期间患者的QTc间期是延长的;插管前1 min静脉注射雷米芬太尼0.75μg/kg,继以0.10 μg/(kg·min)输注可有效抑制气管插管诱发QTc间期延长和血流动力学反应.

Abstract：

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.

Effect of remifentanil on mean arterial pressure, heart rate and QTc interval during tracheal intubation of general anesthesia patients

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.