不同靶浓度瑞芬太尼全麻诱导对心率变异性的影响

The Effect of Different Target Concentration of Remifentanil on Heart Rate Variability

目的研究不同靶浓度瑞芬太尼全麻诱导时对心率变异性（Heart Rate Variability）的影响，及用于气管插管的最佳剂量。方法36例ASAⅠ～Ⅱ级患者，随机分为3组：R2组（瑞芬太尼2ng／ml，n=12），R4组（瑞芬太尼4ng／ml，n=12），R6组（瑞芬太尼6ng／ml，n=12）全麻诱导时给予靶控异丙酚血浆浓度3．5μg／ml，5min后依分组情况给予血浆靶浓度的瑞芬太尼，3min后行气管插管，并记录每分钟的平均动脉压、心率、心率变异性功率谱（HF、LF、HF／LF），并将病人人室后（T0），给瑞芬太尼前（T1），气管插管前（T2），气管插管后5min内的最大值（T3），切皮前（T4）以及切皮后5min内的最大值（L）纳入统计分析。结果靶控输注异丙酚后三组BP、HF、LF均显著降低，靶控输注瑞芬太尼后，R6组HF显著高于R2组，R6组BP低于R2组，R4组、R6组HR较R2组显著降低，插管后、切皮后R2组BP、HR、LF均显著升高。R4组、R6组与插管前相比各指标无显著差异。结论较高靶浓度瑞芬太尼对迷走神经有兴奋作用。在靶控输注异丙酚浓度3．5μg／ml靶控输注瑞芬太尼4ng／ml可以制止插管心交感张力的增高，血流动力学平稳，减少应激刺激。

Objective To evaluate the effect of remifentanil on heart rate variability, to discuss the optimal does of remifentanil for tracheal intubation. Methods Thirty six ASA Ⅰ - Ⅱ patients were randomly assigned to one of three groups （n = 12/group） according to the remifentanil target plasma concentration （2,4,6ng/mL）. No premedication was given. The target -controlled infusion（TCI） of renifentanil was initiated 5 minutes after the TCI of propofol given at the target plasma concentration of 3.5μg/mL. Mean arterial pressure （MAP）, heart rate （HR）, HF, LF, HF/LF were measured from baseline values to 5 minutes after the operation began every minutes. MAP, HR, HF, LF and HF/LF were obtained on the time point as follows： before the induction（ T0）, before the start of remifentanil TCI （ T1 ）, before laryngoscopy（ T2 ）, and maximum values after intubation （ T3 ）, before operation （ T4 ）, maximum values after operation. All the data obtained were analyzed used ANOVA with SPSS 11.5 statistical software. P 〈 0.05 was considered statistically significant. Results MAP, HF, LF reduced significantly after propfol TCI than before. When reminfentanil TCI was given in group R6 HF rose significantly than the in group 112 and MAP reduced significantly than in group R2. HR reduced significantly in group R4 and R6 than in group R2. In group R2 MAP, HR, LF rose significantly after intubation and beginning operation than before. Conclusions High concentration remifentanil can excite pneumogastric nerve. 4ng/mL remifentanil was the optimal dose for the intubation.