靶控输注舒芬太尼对全麻诱导插管期间心率变异性的影响

Effect of Target-controlled Sufentanil Infusion on Heart Rate Variability during Induction and Tracheal Intubation of General Anesthesia

目的探讨不同效应室靶浓度舒芬太尼用于麻醉诱导插管期间心率变异性的变化。方法ASAⅠ～Ⅱ级择期手术病人63例，年龄22～58岁，体重49～60kg，随机分为A、B、C三组，每组21例。在诱导前分别以0．3ng／mL（A组）、0．4ng／mL（B组）、0．5ng／mL（C组）的效应室浓度靶控输注舒芬太尼，达靶浓度后，静推异丙酚1．5mg／kg，咪达唑仑0．03mg／kg，维库溴铵0．1mg／kg进行气管插管，1％异氟醚维持麻醉。Detex-Ohmenda多功能监护仪监测心电图、无创血压、心率、脉搏和动脉氧饱和度，用PI200A型动态心电图仪连续监测心率变异性指标（总功率，高频功率、低频功率、低频高频功率比）。结果靶控输注舒芬太尼后，三组的低频功率和高频功率均下降，其中低频功率下降有显著差异，低频／高频均衡性亦下降。插管前低频功率和高频功率进一步降低。气管插管时B组、C组低频功率的升高明显小于A组，并比A组更早地恢复并维持于较低水平。在血流动力学方面，三组给药及诱导过程中HR、MAP均呈下降趋势。插管刺激使A组MAP明显升高，B、C组无明显变化；A、B组的心率可见轻度升高，C组几乎无变化。观察期间C组出现药物处理的明显低血压和慢心率共计12例。结论靶控输注舒芬太尼可同时抑制交感神经和迷走神经的活性，其中以对交感活性的抑制作用更为显著。0．4ng／mL的效应室浓度既可维持循环系统稳定，又可通过降低交感神经活性有效地抑制插管反应。

Objective To investigate the changes of the heart rate variability caused by different target-control sufentanil concentration during sufentanil balanced anesthesia.Methods Sixty-three ASA physical status Ⅰ, Ⅱ patients scheduled for general anesthesia,age ranges in 22-58y,weigh 49-60kg,were randomized divided into A, B, C groups with each group 21 patients,which were administerd with an effect-site sufentanil target concentration of 0.3ng/mL, 0.4ng/mL, 0.5ng/mL separately before induction.After reaching the effect-site concentratin, anesthesia was induced with propofol 1 .5mg/kg, midazolam 0.03mg/kg and vecuronium 0.1 mg/kg and the trachea intubation was peformed. 1% Isoflurane inhalation helps to maintain the anesthesia.During above process,HR, NBP, SpOE,HRV were monitored continousely by a Detex-Ohmeda monitor and PI200A Hoter Electrocardiograph Monitor.Results After sufentanil infusion,both low and high frequency power decreased significantly compaired with the baseline and the balance of low frequency to high frequency component ratio also decreased.This decline will continue even after anesthesia induction.After tracheal intubation, an mild elevation and a faster recovery of low frequency power component were found in B and C group compared with A group.Hemodynamic observation shows declining trends in all 3 groups during sufentanil infusion and anesthesisa induction.Trachea intubation leads to a significant increasing of MAP in group A but not change much in group B and C.HR shows a mild elevation in group A and B but almost unchanged in group C during the intubation. Twelve patients were found severe hypotension or bradycardia in group C.Conclusions Target-controlled sufentanil infusion mainly depress the sympathetic nervous system, though both the sympathetic and the parasympathetic tone decreased after the infusion. 0.4ng/mL effectsite sufentanil target concentration can depress the stress response effectively while keeping the hemodynamics stable during the induction and intubation of general anesthesia.