不同剂量芬太尼复合丙泊酚对小儿全麻诱导期应激反应的影响

Influence of different doses of fentanyl combined with propofol on stree response during induction of pediatric anaesthesia

目的 观察不同剂量芬太尼诱导气管插管对小儿血流动力学和血浆肾上腺素（E）、去甲肾上腺素（NE）的影响.方法 40例择期全麻患儿,按不同剂量芬太尼随机均分四组：Ⅰ组1.0 μg/kg,Ⅱ组2.0 μg/kg,Ⅲ组2.5 μg/kg,Ⅳ组3.0 μg/kg.诱导使用咪唑安定0.1 mg/kg,芬太尼1.0、2.0、2.5、3.0 μg/kg,丙泊酚2.5 mg/kg和维库溴铵0.1 mg/kg.分别于麻醉诱导前（T0）、诱导后2 min（T1）、插管后1、2 min（T2、T3）记录HR、SBP和DBP.分别于T0、插管后3、5 min（T4、T5）测血浆E和NE浓度.结果 与T0时比较,各组患儿在T1时SBP、DBP均明显下降（P＜0.05或P＜0.01）;T2、T3时Ⅰ组SBP明显增高（P＜0.01）,DBP增高,HR增快,但差异无统计学意义;Ⅱ～Ⅳ组SBP有所下降（P＜0.05或P＜0.01）.T1～T3时Ⅱ～Ⅳ组SBP及Ⅲ、Ⅳ组DBP较Ⅰ组降低（P＜0.05或P＜0.01）;Ⅳ组HR T1时较Ⅰ组减慢（P＜0.05）.T2、T3时Ⅱ～Ⅳ组HR较Ⅰ组减慢（P＜0.05）.Ⅰ组血浆E和NE浓度在T4时明显上升（P＜0.05或P＜0.01）.结论 芬太尼2.0～2.5 μg/kg能较好地抑制小儿全麻诱导气管内插管时的应激反应.

Objective To compare the effects of different doses of fentanyl on haemodynamic and plasma epinephrine（E） and norepinephrine（NE） concentration during induction of anaesthesia. Methods Forty pediatric patients were randomly assigned into four groups according to different doses of fentanyl. Group Ⅰ （fentanyl 1.0 μg/kg）, group Ⅱ （fentanyl 2.0 μg/kg）, group Ⅲ （fentanyl 2.5μg/kg）, group Ⅳ （fentanyl 3.0μg/kg）. Anaesthesia was induced with midazolam 0.1 mg/kg, followed by fentanyl 1.0,2.0,2.5 or 3.0 μg/kg,respectively. Then propofol 2 mg/kg and vecuronium 0.1 mg/kg were given. Blood pressure and heart rate were recorded before induction, at 2 min after induction and 1,2 min after tracheal intubation. The venous blood samples were taken to measure the plasma E and NE before induction,at 3 and 5 rain after intubation. Results There was a significant reduction in SBP and DBP before intubation compared to those before induction in all groups. Tracheal intubation was associated with an increase in SBP,DBP and HR in group Ⅰ and Ⅱ ,reduction in group Ⅲ and Ⅳ. The plasma E and NE concentration increased more at 3 rain after intubation in group Ⅰ , Conclusion Fentanyl 2.0-2.5 μg/kg can prevent stree response during induction of anaesthesia.