瑞芬太尼复合依托咪酯诱导插管的临床观察

Clinical observation of remifentanil and etomidate for induction and endotracheal intubation

目的探讨瑞芬太尼伍用依托咪酯诱导插管时的合适剂量。方法60例ASAⅠ～Ⅱ级全身麻醉择期手术患者，术前无高血压、心脏病、内分泌疾病，预计无插管困难。全部患者随机分为3组，每组20例，依次静注咪唑安定0．05mg／kg，维库溴铵0．1mg／kg，瑞芬太尼（Ⅰ组1μg／kg，Ⅱ组1．5μg／kg，Ⅲ组2μg／kg），依托咪酯0．3mg／kg后诱导插管，于麻醉诱导前、插管前即刻、气管插管后1min、3min、5min、7min记录SBP、DBP、HR、SpO2。结果Ⅰ组诱导后BP、HR平稳，插管后轻度升高，5min后降至诱导前水平；Ⅱ组诱导后BP、HR平稳，插管后轻度升高，3min后降至诱导前水平；Ⅲ组诱导后BP、HR明显下降．插管后3min仍下降明显，5min后升至诱导前水平。结论常规剂量依托咪酯复合1．5μg／kg瑞芬太尼是较为理想的全麻插管诱导剂量。

Objective To investigate the optimal dose for induction and endotracheal intubation using remifentanil and etomidate Methods Sixty ASA Ⅰ - Ⅱ patients without hypertension, heart disease, endocrine disease, and difficulty in intubation underwent elective surgery with general anaesthesia. All patients were randomly divided into three groups and each group had 20 patients. Anesthesia was induced with midazolam 0. 05mg/kg, vecuronium bromide 0. 1mg/kg, remifentanil （Group Ⅰ ,1 μg/kg, Group Ⅱ ,1.5μg/kg, Group Ⅲ , 2ug/kg） and etomidate 0.3mg/kg i. v. by turns and then endotracheal intubated. Systolic blood pressure （SBP）,diastolic blood pressure （DBP）,heart rate （HR）, pulse oxygen saturation（SpO2） before anesthesia induction, endotracheal intubation instantly and 1 min, 3 min, 5 min, 7 min after endotracheal intubation were recorded. Results Bp and HR in Group Ⅰ steadied after induction and lightly increased after endotracheal intubation, and then decreased to the level before induction 5min after endotracheal intubation. Bp and HR in Group Ⅱ steadied after induction and lightly increased after endotracheal intubation, and ten reduced to the level before induction 3 min after endotracheal intubation. Bp and HR in Group Ⅲ decreased significantly after induction, and also decreased significantly 3min after endotracheal intubation, and then increased to the level before induction 5min after endotracheal intubation. Conclusion A combination of 1. 5μg/kg remifentanil and the routine dosage of etomidate is an optimal dose for induction and endotracheal intubation.