不同剂量瑞芬太尼抑制气管插管心血管反应的临床研究

目的探讨不同剂量瑞芬太尼抑制气管插管引起的心血管反应的有效性和合适剂量。方法ASAⅠ-Ⅱ级,全麻下行直肠癌、结肠癌根治术患者60例,按瑞芬太尼剂量不同分为三组:1μg/kg(I组)、2μg/kg(Ⅱ组)、3μg/kg(Ⅲ组);各组麻醉诱导用药依次静注咪唑安定0.04mg/Kg、异丙酚1.5mg/Kg、维库溴胺0.1mg/Kg、瑞芬太尼1μg/kg(Ⅰ组)、2μg/kg(Ⅱ组)、3μg/kg(Ⅲ组)后,经口气管内插管。观察诱导前、诱导后2分钟、导管插入后1、2、3、4、5分钟的血压(SBP、DBP、MAP)和心率(HR)变化,对所得数据进行统计学分析。结果Ⅰ组在气管插管后1分、2分SBP、DBP、MAP、HR均显著增高(p<0.05),而诱导后2分,插管后3分、4分、5分变化不明显(p>0.05)。Ⅱ组在插管后1分、2分、3分、4分SBP、DBP、MAP、HR均没有显著变化,在插管后5分钟与基础值比较有显著性下降(p<0.05)。Ⅲ组在插管后3分、4分、5分SBP、DBP、MAP、HR均显著下降,组间相比明显低于Ⅰ组和Ⅱ组(p<0.05)。在Ⅲ组中有6名患者出现严重低血压,4名患者出现心率小于50次/分。结论Ⅱ组、Ⅲ组均能有效抑制气管插管引起的心血管副反应,但2μg/kg瑞芬太尼为合适剂量,且血流动力学稳定。

Effect of Different Dosage Remifentanil on Inhibit Trachea Intubated Cardiovascular Response

Objective To study the suitable dosage of remifentanil inhibit trachea intubated cardiovascular response.Methods By ASA Ⅰ-Ⅱ,Sixty patients accepted rectectomy with general anesthetics.According to the dosage of remifentanil,they were divided into three group:1μg/kg(group Ⅰ),2μg/kg(group Ⅱ),3μg/kg(group Ⅲ).Each group was introduced with midazolam,propofol,vecurium,remifentanil intravenous injection and tracheal intubation,SBP,DBP,MAP,HR were analyzed statistically at all time.Results Group Ⅰ : SBP、DBP、MAP、HR were significantly increased at post-intubation 1,2min(p<0.05) with no significant change at post-intubation 3,4,5min,and post-intruduction 2min(p>0.05).Group Ⅱ: SBP、DBP、MAP、HR were not significantly changed at post-intubation 1,2,3,4min and significantly decreased at post-intubation 5min(p<0.05).Group Ⅲ : SBP、DBP、MAP、HR were significantly decreased at post-intubation 3,4,5min and compared with group Ⅰ,Ⅱ there was some significant difference(p<0.05).Conclusion 2μg/kg remifentanil can inhibit the trachea intubated cardiovascular response effectively,it can also keep the shed blood dynamics steady.