瑞芬太尼对地氟醚麻醉诱导和气管插管MAC的影响

Effects of Remifentanyl on Induction Characteristics and MAC of Desflurane During Endotracheal Intubation

目的：研究瑞芬太尼对地氟醚麻醉诱导和气管插管MAC的影响。方法：42倒ASAⅠ～Ⅱ级、年龄18～72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两组（n=21），D组：采用地氟醚诱导；R组：采用瑞芬太尼＋地氟醚。记录两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。测定两组地氟醚的半数气管插管最低肺泡浓度（MACEI50）。结果：两组麻醉诱导均很迅速，意识消失时间分别为2．3±0．5min和2．4±0．3min，两组比较无显著差异（P〉0．05）。地氟醚浓度迅速增加后，D组咳嗽的发生率为60％、喉痉挛的发生率为52％，且MAP、HR显著升高。相反，R组很少发生咳嗽和喉痉挛，MAP和HR升高不显著。D组的MACEI50值为2．1±0．4MAC，静泣瑞芬太尼后地氟醚的MACEI50值降至0．9±0．2MAG。结论：地氟醚以及复合瑞芬太尼均能使麻醉诱导迅速，但单用地氟醚气道刺激和心血管反应发生率高；瑞芬太尼可显著减轻其气道刺激和心血管反应，并降低地氟醚的MACEI50。

Objective： To study the Effects of remifentanyl on induction characteristics and MAC of desflurane during endotracheal intubation. Method： Forty -two ASA Ⅰ-Ⅱ patients, aged 18 - 72, undergoing elective lower abdominal operation under general anesthesia, were randomly divided into two groups according to the methods for anesthetic induction. D group： desflurane was used for endotracheal intubation. R group： remifentanyl combined with desflurane was chosen for induction. The time for loss of consciousness,the incidence of coughing and laryngospasm, MAP and HR as well as MAC of desflurane during endotracheal intubation （MACEB0） were recorded. Results： Loss of consciousness was in 2.3 ± 0.5 min and 2.4 ± 0.3 min, respectively. The rapid increase of desflurane concentration resulted in coughing（60% ）, laryngospasm （ 52% ）, and significant increments of MAP and HR during induction in D group. On the contrary, coughing and laryngospasm were rare, and MAP and HR remained stable in R group. MACEI50 was significantly reduced from 2.1 ± 0.4 in D group to 0.9 ± 0.2 in R group. Conclusion： Induction of anesthesia with both only desflurane and desflurane combined with remifentanyl are rapid, but the former can lead to a high incidence of airway and cardiovascular stimuli. Remifentanyl attenuates airway and cardiovascuhr response to desflurane and vroduees a decrease in the MACI50 of desflurane.