靶控输注瑞芬太尼对全麻拔管时血流动力学及心率变异性的影响

Effect of remifentanil by target-controlled infusion on the hemodynamics and heart rate variability during tracheal extubation

目的观察靶控输注(TCI)瑞芬太尼于全麻拔管时对血流动力学及心率变异性的影响。方法择期全麻患者40例,20-50岁,ASAⅠ-Ⅱ,随机分为瑞芬太尼组(R组,n=20)及对照组(C组,n=20)。两组均于手术结束时停瑞芬太尼(3.0-5.0ng/mlTCI)。R组将瑞芬太尼改以1.0ng/ml继续泵入直至拔管时止。监测两组患者手术结束时、拔管时、拔管后收缩压(SBP)、舒张压(DBP)、及心率值(HR),心率变异性指标:低频功率(LF)、高频功率(HF)、LF/HF。结果与手术结束时相比:C组拔管时HR明显增快,SBP、DBP明显升高(P<0.01)。两组拔管时LF、HF,LF/HF均高于手术结束时(P<0.01)。拔管后5min两组LF、HF均高于手术结束时(LF:P<0.01,HF:P<0.05),C组LF/HF高于手术结束时(P<0.01)。R组拔管时及拔管后各对应时点HR慢于C组(P<0.01),SBP低于C组(P<0.01),DBP低于C组(P<0.05)。R组拔管时LF低于C组(P<0.01),LF/HF低于C组,拔管后5minLF、LF/HF低于C组(P<0.05)。结论靶控输注瑞芬太尼1.0ng/ml用于全麻拔管时,可以抑制交感神经活性,降低心血管反应,保持血流动力学稳定。

Objective To explore the effect of remifentanil by target-controlled infusion（TCI） on the hemodynamics and heart rate variability（HRV） during tracheal extubation. Methods Forty ASA Ⅰ - Ⅱ patients aged 22 - 50 years under general anesthesia were randomly divided into remifentanil（R） group and control （C） group （ n = 20 each group）. Remifentanil （3.0 - 5.0 ng/ml, TCI） were ceased at the end of surgery in both two groups. Then remifentanil （ 1.0 ng/ml TCI） in R group were infused until the beginning of tracheal extuhation. HR, SBP, DBP and the value of HRV in two groups were recorded at the end of surgery, during tracheal extuhation and after tracheal extuhation. Results HR, SBP and DBP in C group at the time of tracheal extuhation were higher than that at the end of surgery（P〈 0.01 ）. LF, HF and LF/HF at the time of tracheal extuhation in two groups were higher than that at the end of surgery（P〈0.01）. LF and HF at 5 min after tracheal extuhation in two groups were also higher than that at the end of surgery（LF： P 〈 0.01, HF： P 〈 0.05）. LF/HF in C group were higher at 5 min arter tracheal extubation than at the end of surgery（P 〈 0.01 ）, but there was no significant difference in R group. Compared with C group, HR, SBP and DBP in R group were lower at each time points during and after tracheal extubation（HR, SBP： P〈 0.01, DBP： P〈 0.05）. LF and LF/HF in R group were significantly lower than those in C group during tracheal extuhation（LF：P 〈 0.01, LF/HF： P 〈 0.05）and at 5 min after tracheal extubation（P〈 0.05）. Condusion Remifentanil（1.0 ng/ml） by TCI during tracheal extuhation can inhibit sympathetic activity, depress cardiovascular effects and keep the hemodynamics stable.