不同剂量瑞芬太尼复合异丙酚麻醉诱导对气管插管的血液动力学影响

The Effects of Hemodynamic Reponse to Tracheal Intubation During Induction with Different Doses of Remifentanil in Combination of Propofol

目的比较不同剂量的瑞芬太尼复合异丙酚麻醉诱导对气管插管时的血液动力学影响。方法A SAⅠ-Ⅱ级择期全麻手术病人45例按瑞芬太尼诱导时的不同剂量随机分为3组。诱导:瑞芬太尼(R1组1μg.m-g 1、R2组2μg.m-g 1、R3组3μg.m g-1,90s内推注完。),异丙酚以10m g/10s推速直至意识消失,罗库溴胺0.6m g.kg-1,顺序静脉注射,待肌松满意后行气管插管。分别记录病人入室(30m in后)、诱导后、插管前即刻、插管后1、2、3、4、5m in的血压,心率及异丙酚用量。并观察诱导时有无呛咳,肌僵等并发症。结果3组一般情况差异无显著性,各组插管后的血压均高于插管前即刻,HR无显著变化。麻醉诱导时R2,R3组异丙酚的用量较R1组少,R1组插管反应的发生率较高,麻醉组间比较差异无显著性(P<0.05),R3组诱导时呛咳,肌僵的发生率较高,且循环抑制较强。结论瑞芬太尼复合异丙酚诱导呈现协同作用,以瑞芬太尼2μg.m-g 1为较为合适剂量。

OBJECTIVE To compare the hemodynamic of remifentanil in combination of propofol. METHODS changes after anesthesia induction with different doses Forty-five ASA Ⅰ-Ⅱ patients undergoing electived surgery under general anesthesia were enrollde in this study. The patients were randomized to receive remifentanil 1,2,3μg· mg^-1 except for difficulty in tracheal intubation Propofol were injected with 10mg· 10^-1second until loss of conscious （LOC,no reponse to voice commend and loss of eyelash reflex）. Tracheal was then intubated intubated following intravenous rocuronium 0.6mg·kg^-1. We measured artial blood pressure and heart rate （HR） before anesthesia, induction after induction lmin, 2min, 3min, 4min, 5min, after intubation and induction complications like cough muscle rigid were observed. RESULTS Patients basic cindition were similar in three groups. The propofol dose of anesthesia induction was higher in group R2 than in group R2 and group R3. Arterial blood pressure decreased signigicantly after induction compared with baseline valus, and BP after intubaion of were signigieantly higher than those before intubaion,but there were no signigieantly change in either group. HR remained stable after induction of anesthesia The incidence of intubaion reponse was higher in group R1 complications like cough, muscle rigid circulation depression during induction were higher in group R3 compared with group R1 and group R2. CONCLUSION Induction with different doses of remifentanil in combination of propofol provide positive interaction and the Remifentanil 2μg·mg^-1 is a suitable dose which can effectively attenuate the intubation response.