等效小剂量瑞芬太尼和芬太尼对经口气管插管小儿血流动力学反应的比较

Comparison of Effects of Equipotent Small-Dose Remifentanil and Fentanyl on Hemodynamic Response to Orotracheal Intubation in Children

目的比较等效小剂量瑞芬太尼和芬太尼对经口气管插管小儿血流动力学反应的影响。方法选择择期行全身麻醉下整形外科手术的患儿100例,美国麻醉医师协会(ASA)Ⅰ级或Ⅱ级,随机平均分为2组:瑞芬太尼组(R组)和芬太尼组(F组),在丙泊酚麻醉诱导中采用盲法应用瑞芬太尼2μg/kg或芬太尼2μg/kg。采用直接喉镜经口气管插管。监测麻醉诱导前(基础值)、气管插管前即刻、气管插管即刻和气管插管1、2、3、4、5min时的血压(BP)和心率(HR),计算各观察时间点BP和HR相对于基础值的变化率,并计算二重指数(RPP)。结果2组BP和HR的基础值及气管插管时间均无显著性差异。与基础值比较,虽然气管插管导致F组的BP、HR、RPP及其观察期最大值显著增高,但R组气管插管时BP、HR、RPP及其观察期最大值均较基础值显著降低。观察期时间点的BP、HR、RPP及其最大值二组比较均有显著性差异,观察期时间点的收缩压(SBP)和HR变化率及观察期其最大变化率2组比较亦有显著性差异。观察期SBP和HR增加>基础值30%的发生率在F组显著高于R组;但观察期SBP和HR降低>基础值30%的发生率在R组显著高于F组。结论在小儿应用异丙酚静脉麻醉诱导时,联合应用等效小剂量瑞芬太尼较芬太尼更能有效抑制经口气管插管的血流动力学反应。芬太尼2μg/kg不足以完全抑制小儿经口气管插管的血流动力学反应。虽然瑞芬太尼2μg/kg能够完全消除小儿经口气管插管的血流动力学反应,但可导致更多不良的心血管功能抑制。

Objective To compare the effects of equipotent small - dose remifentanil and fcntanyl on hemodynamic response to orotracheal intubation in children. Methods One hundred children, American Society of Anesthesiologists （ASA） physical status Ⅰ or Ⅱ and scheduled for elective plastic surgery under general anesthesia, were randomly divided into 2 groups to receive the following treatments in a double blind manner： remifcntanil 2 μg/kg（ group R） or fentanyl 2 μg/kg （group F） （50 cases each group）when anesthesia was induced with propofol. The orotracheal intubation was performed by the direct laryngoscope. Blood pressure（BP） and heart rate（HR） were recorded before anesthesia induction （ baseline values） ,immediately before intubation, on intubation each minute for 5 minutes after intubation. Percent changes of systolic blood pressure（SBP） and HR relative to baseline values at each observing point were calculated. The rate pressure product （RPP） at each time point was also calculated. Results There were no significant differences between 2 groups in demographic data,baseline values of BP and HR and the intubation time. In group F,tracheal intubation caused significant increases in BP,HR and RPP compared with baseline values. In group R, BP, HR and RPP on intubation and their maximum values during the observation decreased significantly compared with baseline values. BP, HR and RPP at all observing points and their maximum values during the observation were significantly different between 2 groups. There were also significant differences between 2 groups in the percent changes of SBP and HR relative to baseline values at all observing points and their maximum percent changes during the observation. The incidences of SBP and HR percent increases 〉 30% of baseline values were significantly higher in group F than those in group R, but the incidences of SBP and HR percent decreases 〉 30% of baseline values were significantly higher in group R compared with group F. Conclusions When anesthesia was induced with propofol in children, co - adminiatration of equipotent small - dose remifentanil is more effective in attenuating the hemodynamic responses to orotracheal intubation than co - adminiatration of equipotent small - dose fentanyl. Fentanyl 2 μg/kg fails to completely depress the hemodynamic response to orotraeheal intubation in children. Remifentanil 2 μg/kg can completely abolish the hemodynamics response to orotracheal intubation, but may cause more adverse cardiovascular depression