瑞芬太尼与芬太尼对小儿全麻中心率变异性的影响

目的:研究瑞芬太尼在小儿全麻中对心率变异性的影响。方法:140例患儿随机分为:瑞芬太尼组(R组)和芬太尼组(F组)。观察入室(T0)、诱导后(T1)、置入喉罩(T2)、切皮(T3)、术毕(T4)、拔出喉罩后5 min(T5)的LF/HF、HRVI、HR、Sp02,清醒及留观时间、手法辅助通气、拔出喉罩后不良反应的发生率。结果:与入室比较,R组的LF/HF、HRVI、HR在T1～T4显著降低,F组的在T2、T3显著升高,在T1、T4、T5降低(P<0.05),Sp02在T1～T5降低(P<0.05);两组比较,在T1～T4R组HRVI、LF/HF、HR均低于F组(P<0.05),Sp02均高于于F组(P<0.05);患者清醒时间和留观时间R组短于F组(P<0.05);R组术中不良反应的发生率低于F组(P<0.05)。结论:瑞芬太尼用于小儿全麻中,能维持血流动力学平稳、抑制自主神经功能、提高术后苏醒质量。

Influence of remifentanil and fentanyl on heart rate variability of children undergoing general anesthesia

Objective: To evaluate the influence of general anesthesia with remifentanil on HRV in children.Methods: One hundred and forty children were randomized into remifentanil group(n=70) and fentanyl group(n=70).Change of ratio of low frequency and high frequency(LF/HF),heart rate variability index(HRVI),HR,Sp02 scores were observed respectively pre-administration(T0),received medicine(T1),straight into a laryngeal mask(T2),cut skin(T3),after operation(T4) and 5min after pulling out a laryngeal mask(T5),At the same time,the revival time and staying time,the phenomenon of respiratory inhibition,limb dynamic response,and the adverse reaction after pull out a laryngeal mask were observed too.Results: In the two group,LF/HF,HRVI,HR of group R were lower at T1~ T4 than at T0(P<0.05);LF/HF,HRVI,HR of group F were higher at T2,T3 at T0(P<0.05),but,lower at T1,T4,T5 than at T0(P<0.05).Sp02 was lower at T1~T5 than at T0(P<0.05).All of the records of HRVI,LF/HF,HR were lower in group R than in group F at T1~T4,but Sp02 was lower(P<0.05).The revival time and staying time in group R was shorter than group F(P<0.05).The phenomenon of respiratory inhibition,the adverse reaction after pull out a laryngeal mask were lower in group R than group F(P<0.05).Conclusion: Remifentanil can maintain stable hemodynamics,inhibit autonomic nerve during anesthesia and improve the quality of waking after operation.