小剂量瑞芬太尼和芬太尼预防小儿经口气管插管血液动力学反应的比较

Comparison of small dose remifentanil and fentanyl for prevention of hemodynamic responses to orotracheal intubation in children

目的比较小剂量瑞芬太尼和芬太尼对小儿经口气管插管血液动力学反应的影响。方法择期在全身麻醉下行整形外科手术患儿90例,ASAⅠ或Ⅱ级,年龄3-9岁,随机分为3组(n= 30):对照组(C组)、芬太尼组(F组)和瑞芬太尼组(R组)。气管插管前5 min行麻醉诱导,C组和F组分别静脉注射生理盐水0．2 ml／kg或芬太尼2μg／kg,插管前2 min三组均静脉注射维库溴铵0．1 mg／kg和异丙酚2．5 mg／kg,插管前1．5 min R组在30 s内静脉输注瑞芬太尼1μg／kg。采用直接喉镜行经口气管插管。记录麻醉诱导前(基础值)、诱导后即刻、气管插管时和插管后1、2、3、4、5 min时的血压和心率(HR),计算各对应时点HR和收缩压(SBP)的乘积(RPP)。记录插管时间、从插管操作开始至出现SBP和HR最大值的时间(TMAX-SBP和TMAX-HR)以及从插管操作完成至SBP和HR恢复至诱导后即刻值的时间(TR-SBP和TR-HR)。结果与基础值相比,诱导后即刻各组血压均降低,F组和R组降低较C组明显(P<0．05),C组HR增快(P<0．05),F组和R组HR保持稳定;气管插管致各组血压、HR和RPP升高(P<0．05),以C组最为明显,R组最轻;R组TMAX-SBP和TMAX-HR长于C组和F组,TR-SBP和TR-HR短于C组和F组(P<0．05)。结论与小剂量芬太尼相比,小剂量瑞芬太尼可更有效地抑制小儿经口气管插管的血液动力学反应。

Objective To compare the effects of small dose remifentanil and fentanyl on hemodynamie responses to orotracheal intubation in children. Methods Ninety ASA Ⅰ or Ⅱ children （57 males, 33 females） aged 3-9 yrs weighing 17-34 kg scheduled for elective plastic surgery under general, anesthesia were randomly allocated to one of 3 groups （ n = 30 each） ： group Ⅰ control （C） ; group Ⅱ fcntanyl （F） and group m remffentanil （R）. The children were premedicated with intramuscular scopolamine 0.01 mg· kg^-1 （the maximum dose 0. 3 mg） and midazolam 0. 1 mg· kg^-1 . Anesthesia was induced with propofol 2.5 mg· kg^-1 and vccuronium 0. 1 mg· kg^- 1 . In group F fentanyl 2μg·kg^-1 was injected Ⅳ 5 min before intubation while in group R remifcntanil 1 μg·kg^-1 was injected Ⅳ over 30 seconds immediately after vecuronium. Tracheal intubation was performed at 2 min after vecurenium injection. Noninvasive BP and HR were recorded and RPP （SBP × HR） was calculated before （basdine） and immediately after induction （T1）, during intubation （T2） and at 1, 2, 3, 4, 5 rain after intubation. Results BP was significantly decreased after induction of anesthesia （T1） as compared to the baseline values in all 3 groups （ P 〈 0. 05 ）, while HR was significantly increased at T1 in control group but remained stable in group F and R. Orotracheal intubation caused significant increase in BP, HR and RPP as compared to the baseline values. The intubation responses were strongest in control group and least in group R. SBP and HR reached their highest values significantly later and returned to post-induction （T1） levet significantly faster in group R than in group C and F. Conclusion Small dose remifentanil can blunt the hemodynamic responses to tracheal intubation more effectively than small dose fentanyl in children.