不同剂量雷米芬太尼对气管插管反应的影响

Effects of different dosage of remifentanil on cardiovascular response to tracheal intubation

目的观察不同剂量雷米芬太尼用于全麻诱导气管插管时的心血管反应,探讨其最佳的全麻诱导剂量。方法将96例择期行腹部手术的患者随机均分为四组。全麻诱导均采用咪唑安定0.06mg/kg、依托咪酯0.3mg/kg、维库溴铵0.1mg/kg;雷米芬太尼剂量分别为1μg/kg(R1组)、2μg/kg(R2组)、3μg/kg(R3组)和4μg/kg(R4组)。记录诱导前(T0)、诱导后气管插管前(T1)、气管插管后即刻(T2)、气管插管后1min(T3)、2min(T4)、3min(T5)、5min(T6)和10min(T7)的SBP、DBP、HR的变化。结果与T0比较,各组T1时SBP、DBP均明显下降(P<0.05或P<0.01),R1组T2、T3时SBP显著升高(P<0.05)。与T0比较,各组患者T1时的HR均明显减慢(P<0.01),R1组患者T2、T3时HR显著增快(P<0.05或P<0.01)。R2、R3组气管插管期间血压波动幅度均较R1、R4组小(P<0.05)。结论采用2～3μg/kg的雷米芬太尼麻醉诱导可有效抑制气管插管时的心血管反应。

Objective To observe the effects of different dosage of remifentanil on cardiovascular response to tracheal intubation. Methods Ninety-six patients undergoing abdominal surgery were randomly divided into four groups with 24 cases each. Anesthesia was induced with midazolam 0.06 mg/kg, etomidate 0.3 mg/kg and vecuronium 0.1 mg/kg and remifentanil was injected in a dose of 1/μg/kg in R1 group,2μg/kg in R2 group,3μg/kg in Rs group and 4/tg/kg in R4 group,respectively. Blood pressure （BP） and heart rate （HR） were recorded before induction of anesthesia （To）,just after induction of anesthesia （T1）,just after tracheal intubation （T2）,at 1 min （Ts）,2 min （T4）, 3 min （T5）, 5 min （T6） and 10 min （T7） min after tracheal intubation. Results Compared to T0,BP in four groups was significantly decreased at T2 （P〈0.05）,but in R1 group increased markedly at T2 and T3 （P〈0.05）, so did the H R （P〈0.01 or P〈0.05）. The change of BP was less in R2 group and Rs group than that in R1 and R4 groups （P〈0.05）. Conclusion Remifentanil 2-3 μg/kg intravenous injection during induction of anesthesia can suppress the cardiovascular response to tracheal intubation.