瑞芬太尼复合异丙酚用于全麻诱导气管插管的最佳剂量临床研究

目的:研究连续输注瑞芬太尼复合异丙酚用于全麻诱导气管插管的最佳剂量。方法:80例ASAⅠ～Ⅱ级患者随机分为A、B、C、D 4组,每组20例。诱导开始时,A、B、C、D 4组分别以0.4μg.kg-1.min-1、0.5μg.kg-1.min-1、0.6μg.kg-1.min-1、0.7μg.kg-1.min-1的速度输注瑞芬太尼。2分钟后静注异丙酚1.5mg.kg-1,过1.5分钟后静注罗库溴铵0.6mg.kg-1,再过1.5分钟后行气管插管。同时调整瑞芬太尼的输注速度均为0.1μg.kg-1.min-1,并以4mg.kg-1.h-1的速度输注异丙酚。记录不同时间SBP、DBP、MAP、HR以及有无呛咳、肌肉僵直等不良反应和血管活性药物的使用情况。结果:4组患者在插管前即刻MAP及HR较诱导前基础值均有不同程度下降(P<0.05),其中D组HR较A组下降更显著(P<0.05);插管后A组MAP和HR立即上升超过诱导前基础值(P<0.05),且持续到插管后2分钟(T5);插管后B、C组MAP和HR恢复,与诱导前基础值比较差异无统计学意义(P>0.05);插管后D组MAP仍然低于诱导前基础值(P<0.05),且持续到插管后5分钟(T8);A组和D组分别有10例(50%)和8例(40%)患者需要使用血管活性药物,高于B组2例(10%)和C组0例(0%)(P<0.05)。所有患者均未出现呛咳及影响通气的肌肉僵直。结论:全麻诱导期间连续输注瑞芬太尼5分钟能够呈剂量相关地抑制气管插管的血流动力学变化,无呛咳和影响通气的肌肉僵直,当复合异丙酚1.5mg.kg-1时,瑞芬太尼输注速度以0.5～0.6μg.kg-1.min-1为佳,血流动力学更稳定。

Clinical study on best dosage of continuous intravenous remifentanil combined with propofol for anesthetic induction and tracheal intubation

Objective:To investigate the best dosage of continuous intravenous remifentanil combined with propofol for anesthetic induction and tracheal intubation.Methods:Eighty ASA Ⅰ ~ Ⅱ patients were randomly allocated to one of four groups of 20 each:group A,B,C and D.Anaesthesia was induced with remifentanil 0.4,0.5,0.6 or 0.7μg.kg-1.min-1 for group A,B,C and D,respectively.Each patient was administered 1.5 mg.kg-1 propofol 2 min after the start of remifentanil infusion,and 0.6 mg.kg-1 rocuronium 1.5 min after propofol injection.Tracheal intubation was performed 1.5 min after rocuronium injection,and each patient was administered 0.1μg.kg-1.min-1 remifentanil and 4 mg.kg-1.h-1 propofol at this time point.Noninvasive blood pressure and heart rate were recorded before anesthetic induction(T1),immediately before intubation(T2),immediately after intubation(T3),1 min after intubation(T4),2 min after intubation(T5),3 min after intubation(T6),4 min after intubation(T7),and 5 min after intubation(T8).The adverse effects like cough and muscle rigidity and use of vasoactive agents were also recorded.Results:MAP and HR decreased in all groups at T2(P<0.05),and HR was lower in group D than in group A at this time point(P<0.05).After intubation,MAP and HR increased immediately and were higher compared with the baseline value till T5 in group A(P<0.05).There was no difference in MAP and HR compared with the baseline value after intubation in group B and C(P>0.05).MAP remained below the baseline value after intubation till T8 in group D(P<0.05).There were more patients needing vasoactive agents in group A and D than in group B and C(P<0.05).No patient among the four groups presented with cough and muscle rigidity.Conclusion:Continuous intravenous remifentanil for 5 min produced a dose-related attenuation of the haemodynamic response to tracheal intubation without adverse effects like cough and muscle rigidity,and remifentanil 0.5-0.6μg.kg-1.min-1 combined with 1.5 mg.kg-1 propofol maintained more stable hemodynamics.