全麻诱导期芬太尼复合不同静脉麻醉药时适宜用量的探讨

Optimal dosage of fentanyl combined with intravenous anesthetics during anesthesia induction

目的探讨全麻诱导期芬太尼复合静脉麻醉药时,既能预防气管插管心血管应激反应,又无过度降压效应的适宜剂量。方法全麻气管插管下择期手术患者162例,按麻醉配方分7组:组1硫喷妥钠5 mg/kg,芬太尼7μg/kg(n=25);组2依托咪酯0.3 mg/kg,芬太尼7μg/kg(n=28);组3依托咪酯0.3 mg/kg,芬太尼5μg/kg(n=27);组4咪唑安定(力月西)0.05 mg/kg,依托咪酯0.3 mg/kg,芬太尼6μg/kg(n=22);组5异丙酚2 mg/kg,芬太尼7μg/kg(n=15);组6异丙酚2 mg/kg,芬太尼5μg/kg(n=15);组7异丙酚2 mg/kg,芬太尼3μg/kg(n=30)。记录麻醉诱导前、诱导后、插管即刻、插管后1、3、5、7、10 min收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)。结果各组进行自身对照,与基础值比较:组1,SBP、DBP和MAP在诱导后、插管后5、7、10 min明显降低(P<0.05),HR在诱导后和插管1 min明显增快(P<0.05)。组2,各项指标在各时点之间无显著差异(P>0.05)。组3,SBP在插管1 min时显著增高(P<0.01)。组4,仅SBP在诱导后明显降低(P<0.05)。组5,SBP、DBP、MAP在诱导后和插管后各时点显著降低(P<0.01)。组6,SBP、DBP、MAP在诱导后和插管后7、10 min显著降低(P<0.01)。组7,SBP、DBP、MAP仅在诱导后显著降低(P<0.01)。结论静脉麻醉药在推荐的诱导剂量基础上,硫喷妥钠或依托咪酯伍用芬太尼7μg/kg,依托咪酯加咪唑安定伍用芬太尼6μg/kg,异丙酚伍用芬太尼3μg/kg较为适宜。

Objective To investigate optimal dosage of fentanyl combined with intravenous anesthetics for the prevention of hemodynamic changes to endotraeheal intubation during anesthesia induction. Methods 162 patients were randomly divided into seven groups： group Ⅰ thiopental 5 mg/kg and fentanyl 7 μg/kg （n=25）; group Ⅱ etomidate 0. 8 mg/kg and fentanyl 7μg/kg （n= 28）; group Ⅲ etomidate 0. 3 mg/kg and fentanyl 5 μg/kg （n = 27）; group Ⅳ midazolam 0. 05 mg/kg, etomidate 0.3 mg/kg and fentanyl 6 μg/kg （n=22）; group Ⅴ propofol 2 mg/kg and fentayl 7μg/kg （n=15）; group Ⅵ propofol 2 mg/kg and fentanyl 5 μg/kg （n=15）; group Ⅶ propofol 2 mg/kg and fentanyl 3 μg/kg （n=30）. SBP,DBP ,MAP,HR,RPP were monitored before and after induction, 0, 1,3,5,7,10 min after intubations. Results SBP,DBP,MAP decreased after induction, and 5,7,10 min after intubations. HR increased 1 min after intubation in group Ⅰ （P〈0.05）. Hemodynamics was stable during anesthesia induction in group Ⅱ . SBP increased 1 min after intubation in group Ⅲ （P〈0.01）. SBP decreased after induction in group Ⅳ （P〈 0. 05）. SBP, DBP,MAP decreased significantly during induction and intubations in group Ⅴ （P〈0. 01）. SBP,DBP,MAP decreased after intubations and 7,10 rain after intubations in group Ⅵ （P〈0.01）. SBP,DBP,MAP decreased only after inductions in group Ⅶ （P〈0.01）. Conclusion Fentanyl 7μg/kg combined with thiopental or etomidate, fentanyl 6 μg/kg combined with midazolam and etomidate, fentanyl 3μg/kg combined with propofol are optimum dose of the prevention of homonymic response to end-intubations during anesthesia induction.