瑞芬太尼预防气管插管所致心血管反应的观察

Efficacy and safety of remifentanil in the management of cardiovascular responses due to tracheal intubation

目的:比较不同剂量国产瑞芬太尼持续输注减弱气管插管引起的心血管反应的效果和安全性。方法:140例ASA I级整形外科患者,随机分为0．1(n=40),0．2(n=40),0．3(n=20),0．4(n=20)．0．5μg·kg-1·min-1(n=20)5个剂量组。用1μg·kg-1瑞芬太尼静脉注射后分别静注0．1～0．5μg·kg-1·min-1瑞芬太尼,静注丙泊酚、罗库澳铵后气管插管。记录诱导前5 min,诱导后1,2,3 min,插管后1,2,3,4 min的心率(HR)和血压。结果:5组患者诱导后2,3 min,插管后备时间收缩压和平均动脉压均下降,部分时间点舒张压显著下降(P<0．05)。插管后0．1μg组HR显著加快,0．2μg{组HR变化不明显,0．3-0．5μg·kg-1·min-1组插管后HR轻微短暂增快,但很快下降接近基础值。结论:瑞芬太尼维持输注0．2-0．5μg·kg-1·min-1能有效地减弱气管插管引起的心血管反应。

Objective： To evaluate the efficacy and safety of intravenous remifentanil made in China in the management of cardiovascular responses induced by tracheal intubation. Methods： 140 ASA Ⅰ patients who underwent plastic surgeries were randomly enrolled to five remifentanil groups, each anesthetized with remifentanil at loading iv dosing of 1 μg· kg^ -1 , and then given with remifentanil by intravenous infusion at doses of 0.1 （n=40）, 0.2 （n=40）, 0.3 （n =20）, 0.4 （n=20） or0.5 （n=20） μg·kg^-1 ·min^-1. Intubation was facilitated with propofol 2 mg·kg^ -1 and rocuronium 0.8 mg.kg^-1. Both blood pressure （BP） and heart rate （HR） were measured 5 minutes pre-anesthesic induction,1,2,and 3 minutes post the induction, and 1, 2, 3, and 4 minutes post the intubation. Results： The patients showed decreases of SBP and mean arterial pressure （MAP） at 2 and 3 minutes post the induction and 1, 2, 3, and 4 minutes post the intubation, and a significant reduction of DBP at certain time points （P 〈 0. 05） post the intubation. The patients at 0. 1 μg. kg^-1· min^ -1 of remifentanil experienced a significant fasterHR, at 0. 2 μg.kg^-1.min^-1 showed no significant change of HR, and at 0.3 - 0.5 μg ·kg^-1· min^-1 were found to be back close to baseline value of HR after a mild but shorter escalation of HR post the intubation. Conclusion ： Remifentanil at maintenance infusion of 0. 2 - 0. 5 μg. kg^-1.min^ -1 was effective and safe to manage cardiovascular response due to the tracheal intubation.