瑞芬太尼与舒芬太尼抑制患者气管插管血液动力学反应效果的比较

Comparison of effects of remifentanil and sufentanil blunting the hemodynamic responses to tracheal intubation performed in patients

目的比较等效剂量的瑞芬太尼与舒芬太尼抑制患者气管插管血液动力学反应的效果。方法择期腹部手术患者166例,ASAⅠ级或Ⅱ级,年龄18～63岁。随机分为两组:瑞芬太尼组(R组,n=83)和舒芬太尼组(S组,n=83)。麻醉诱导:静脉注射咪达唑仑0.1mg/kg、异丙酚2.5mg/kg、瑞芬太尼1μg/kg(R组)或舒芬太尼0.1μg/kg(S组)、维库溴铵0.1mg/kg,气管插管后机械通气。于麻醉诱导前(基础值)、气管插管前后即刻、气管插管后1min、3min、5min时记录SP、DP、MAP和HR,观察气管插管反应的发生情况。结果与基础值比较,两组其余时间点血液动力学指标均降低(P<0.05),且R组低于S组(P<0.05);S组BP和HR最大值较基础值升高,R组较基础值降低(P<0.05)。结论在复合异丙酚-维库溴铵麻醉诱导时,等效剂量的瑞芬太尼较舒芬太尼抑制患者气管插管血液动力学反应的效果好。

Objective To investigate the effects of remifentanil and sufentanil blunting the hemodynamie responses to tracheal intubation performed in patients. Methods One hundred and sisty-six patients of both sexes, ASA Ⅰ or Ⅱ, aged 18 - 63years, weighing 42-90 kg, scheduled for elective abdominal surgery, were randomly divided into 2 groups （ n=83 each）： remifentanil group （group R） and sufentanil goup （group S）. Anesthesia was induced with midazolam 0.1 mg/kg, propofol 2.5 rag/ kg, remifentanil lp, g/kg （group R） or sufentanil 0.1μg/kg （grop S）. Tracheal intubation was facilitated with vecuronium 0.1 mg/ kg. The patients were maehanically ventilated. Hemodynamic measurements （SP, DP, MAP, HR） were monitored and recorded before and after induction, and at 0 min, 1 min, 3 min, 5 min after tracheal intubation. The adverse cardiovascular events including bradycardia, taehycardia, hypertension and hypotension, and the＇hemodynamic responses to tracheal intubation were also recorded. Results There were no significant differences between two groups in SP, DP,MAP, HR before induction （P〉0.05）. The incidence of tracheal intubation response was significantly higher in group S than that in group R. Conclusion The effect of remifentanil blunting the hemodynamic responses to tracheal intubation performed in patients is better than that of sufentanil in anesthesia with propofol-veeuronium combinded induction.