瑞芬太尼对气管内插管时血流动力学及血糖、皮质醇的影响

目的以芬太尼作对照,观察使用瑞芬太尼行全身麻醉快速诱导窥喉和气管插管时对血流动力学的影响及血糖、皮质醇的变化。方法24例ASAⅠ-Ⅱ级的全麻患者,随机平均分为2组:瑞芬太尼组(RF).芬太尼组(F)。RF组在静注维库溴铵0.1mg/kg,异丙酚1.5mg/kg后,予瑞芬太尼1μg/kg(以生理盐水稀释为20ml,输入时间大于30s),60s后插管;F组静注芬太尼3μg/kg,维库溴铵0.1mg/kg,异丙酚1.5mg/kg,3min后插管。连续监测插管前后血流动力学及血糖、皮质醇的变化。结果R组患者插管前血压降低,与基础值比较组内差异有显著性(P<0.05),HR略减慢。插管后各项参数变化与基础值比较组内差异无统计学意义。F组患者插管前血压略降低、HR略减慢,但与基础值比较无统计学差异;插管后1,3minSBp、DBp增高;HR增快,与基础值比较组内差异有显著性(P<0.05)。且5min时DBp、HR仍显著高于基础值。两组基础HR、SBp、DBp无显著性差异。诱导后RF组SBp、DBp显著低于F组(P<0.05);RF组插管后1min的HR、SBp、DBp;插管后3min的SBp、DBp;插管后5min的DBp均显著低于F组(P<0.05)。两组血糖在插管后差异不显著。皮质醇浓度在插管后R组降低,F组则升高,两组比较,有显著性差异(P<0.05)。结论插管前静脉注入瑞芬太尼通常可较好地抑制窥喉和气管插管时的应激反应,且优?

Effect of remifentanil on the haemodynamic response and blood sugar and cortisol to tracheal intubation

Objective To compare the effect of fentanyl and remifentanil on the haemodynamic response to laryn-goscopy and tracheal intubation and the changes of plasm concentration of blood sugar and cortisol during rapid sequence induction of anaesthesia. Methods 24 ASA Ⅰ - Ⅱ patients were randomly divided into two groups: remifentanil group (group RF, n= 12), fentanyl group(group F, n= 12). In group RF anaesthesia was induced with vecuronium 0. 1 mg/kg and propofol 1. 5 mg/kg followed by remifentanil 1. 0 given as a bolus over 30s(diluted to 20ml with saline) . Laryn-goscopy and tracheal intubation were performed 60s later. In group F anaesthesia was induced with vecuronium 0. 1mg/kg and propofol 1. 5mg/kg and fentanyl 3. 0 μg/kg, Laryngoscopy and tracheal intubation were performed 3min later. Changes of haemodynamics and plasm concentration of blood sugar and cortisol were recorded continuously. Results BP in group RF after induction was significantly lower than baseline ( P < 0.05 ), followed "with lower HR. And no changes of haemodynamic response was found in group RF after intubation, compared with those of pre - induction. In group F BP and HR were lower pre - intubation and there was no significance compared with baseline. The BP and HR in group F increased significantly l,3min after intubation, compared with those of pre- induction (P< 0.05). And DBp,HR could last until 5min after intubation. The haemodynamic response parameters of two groups were similar in baseline. SBp,DBp in group RF after induction was significantly lower than those in group F (P<0.05) . HR,SBp,DBp in group RF 1 min after intubation ; SBp,DBp 3min after intubation ; DBp 5min after intubation was significantly lower than those in group F ( P < 0.05). Blood sugar level in group RF after intubation was not significantly different from those in group F butcor-tisol level decreased significantly ( P < 0.05 ) . Conclusion Remifentanil could depress the stress response to laryngoscopy and tracheal intubation effectively and better than minidose fentanyl.