摘要
目的:研究瑞芬太尼对婴儿先天性心脏病矫正术麻醉诱导期血流动力学及神经肽Y(neuropeptide Y,NPY)的影响,确定适合于婴儿的最佳剂量,为瑞芬太尼的临床应用提供依据。方法:选择拟在体外循环下行房间隔缺损(ASD)或室间隔缺损(VSD)修补术的先天性心脏病婴儿40例,随机进入4种不同剂量瑞芬太尼组[各组10例,0.25μg/kg组、0.50μg/kg组、1.0μg/kg组、2.0μg/kg组]进行麻醉诱导,分别于用药前(进行血气分析)、气管插管后2分钟、5分钟抽取动脉血,测定NPY,记录相应时点的心率,平均动脉压。结果:①心率变化:1.0、2.0μg/kg组气管插管后2分钟、5分钟较用药前下降,均有显著性差异(P＜0.05～0.01)。气管插管后2分钟1.0μg/kg组较0.25μg/kg组和气管插管后2分钟、5分钟2.0μg/kg组均较0.25μg/kg组下降,均有显著性差异(P＜0.05)。②平均动脉压变化:1.0、2.0μg/kg组气管插管后2分钟、5分钟较用药前下降,均有显著性差异(P＜0.05～0.01)。气管插管后2分钟、5分钟0.5、1.0、2.0μg/kg 3组均较0.25μg/kg组下降,有显著性差异(P＜0.05)。③NPY含量变化:1.0、2.0μg/kg组气管插管后2分钟、5分钟较用药前下降,均有显著性差异(P＜0.05～0.01)。气管插管后2分钟,1.0、2.0μg/kg组较0.25μg/kg组也下降,有显著性差异(P＜0.05)。结论:瑞芬太尼用于ASD或VSD修补术患儿麻醉诱导可行性良好,剂量以0.25～0.50μg/kg为佳,可以有效的抑制气管插管应激反应,维持血流动力学稳定,抑制NPY释放。
Objective： To investigate the effects of remifentanil on hemodynemics and neuropeptiok （NPY）, in infants undergoing congenital heart surgery during induction, and to determine the optimum doses for infants, thus providing evidence for the clinical practice. Methods： Forty congenital heart desease infants undergoing ASD or VSD procedures were selected. They were randomized to four different remifentanil groups （ D1：0. 25 μg/kg, D2：0. 5 μg/kg, D3 ： 1.0 μg/kg, IM：2.0 μg/kg） to receive anesthesia induction. Blood samples were obtained at T1 （ before administration）, T2,33 （ 2 and 5 rain after tracheal intubation ） for blood gas analysis and plasma levels of NPY. HR, MAP were also recorded. Results： No statistical significant changes of MAP, HR and NPY were identified （P 〉 0. 05 ）in infants of DI and D2 groups. In group D3, there was reduced MAP, HR （P 〈 0. 01 ） and NPY（ P 〈 0. 05 ） at T2. However, MAP, HR and NPY were obviously decreased（P 〈 0. 01 ） in group IM at T2 and 33. Conclusion ： In infants undergoing ASD or VSD procedures, remifentanil dosages of 0. 25 and 0. 50 μg/kg can effectively suppress the tracheal intubation stress response and suppress plasma NPY increase and maintain stable hemodynamies. Remifentanil should be used with caution in infant with congenital heart disease.
出处
《中国循环杂志》
CSCD
北大核心
2006年第6期465-468,共4页
Chinese Circulation Journal
