瑞芬太尼及芬太尼对异氟醚麻醉诱导和气管插管最低肺泡浓度的影响

Effects of remifentanil and fentanyl on anesthetic induction by isoflurane and MAC during endotracheal intubation

目的 比较瑞芬太尼及芬太尼对异氟醚麻醉诱导和气管插管最低肺泡浓度 (MAC)的影响。方法 60例ASAⅠ～Ⅱ级、年龄 16～ 70岁、择期在全麻下行下腹部手术的患者 ,按麻醉诱导方法的不同随机分为 3组 (各 2 0例 ) ,I组 :采用异氟醚诱导 ;R组 :采用瑞芬太尼 +异氟醚 ;F组 :采用芬太尼 +异氟醚。记录 3组麻醉诱导时意识消失时间 ,诱导前MAP、HR ,诱导过程MAP、HR峰值以及咳嗽、喉痉挛、过度分泌及体动情况。测定三组异氟醚的半数气管插管最低肺泡浓度 (MACEI50 )。结果 R组意识消失时间为 (2 .3± 0 .3 )min ,明显短于I组 (5 .2± 0 .8)min及F组 (4 .6± 0 .7)min(P <0 .0 1) ,而I组与F组比较差异无显著性 (P >0 .0 5 )。异氟醚浓度迅速增加后 ,I组咳嗽的发生率为 60 %、喉痉挛的发生率为 5 2 % ,且MAP、HR显著升高。相反 ,R组与F组很少发生咳嗽和喉痉挛 ,MAP和HR升高不显著。I组的MACEI50 值为 (1.9± 0 .3 )MAC ,静脉注射瑞芬太尼及芬太尼后异氟醚的MACEI50 值分别降至 (0 .8±0 .2 )MAC及 (1.2± 0 .2 )MAC。结论 异氟醚复合瑞芬太尼能使麻醉诱导迅速 ,但单用异氟醚气道刺激和心血管反应发生率高 ;瑞芬太尼及芬太尼可显著减轻患者的气道刺激和心血管反应 ,并能同时降低异氟醚的MACEI50 。

Objectve To investigate the effects of remifentanil and fentanyl on anesthetic induction by isoflur and MAC during endotracheal intubation.Methods Sixty ASA Ⅰ～Ⅱ patients (age range:16～70yr),undergoing elective lower abdominal operation under general anesthesia,were randomly divided into three groups according to the methods of anesthetic induction.Group I:isoflurane was used for endotracheal intubation;group R:remifentanil combined with isoflurane was chosen for induction;group F:fentanyl combined with isoflurane was chosen for induction.The time for loss of consciousness,the incidence of cough and laryngospasm,MAP and HR as well as MAC of isoflurane during endotracheal intubation (MACEI 50 ) were recorded.Results In group R,loss of consciousness (2.3±0.3) min was significantly shorter than that in group I (5.2±0.8) min and group F(4.6±0.7) min (P<0.01).The rapid increase of isoflurane concentration resulted in cough (60%),laryngospasm (52%),and significant increment of MAP and HR during induction in group I.On the contrary,cough and laryngospasm were rare,and MAP and HR remained stable in group R and group F.MACEI 50 was significantly reduced in group I from 1.9±0.3 to 0.8±0.2 MAC in group R,and to 1.2±0.2 MAC in group F (P<0.05).There was no significant difference for MACEI 50 between group R and group F (P>0.05).Conclusion The anesthetic induction by isoflurane combined with remifentanyl is faster,as compared with that of isoflurane combined with fentanyl;remifentanil and fentanyl can attenuate airway and cardiovascular response to isoflurane and produce a decrease in the MACEI 50 of isoflurane.