芬太尼对七氟醚麻醉诱导的影响

The Effect of Fentanyl on Anesthesia Induction with Sevoflurane Inhalation

目的和方法：研究了２０例择期手术病人单吸七氟醚或七氟醚复合静注芬太尼麻醉诱导对呼吸、循环、量化脑电、肌电活动（ＥＥＧ、ＥＭＧ）及插管反应的影响。结果：芬太尼显著缩短七氟醚致意识、痛觉消失的时间（Ｐ分别＜０．０５和０．０１），并明显减少无意识肢动发生率。七氟醚呈浓度依赖性抑制呼吸：ＶＴ降低、呼吸频率减慢、ＰＥＴＣＯ２递增，芬太尼不加重其抑制效应。七氟醚在１．０、１．３ＭＡＣ时使ＳＢＰ和ＤＢＰ显著降低（Ｐ均＜０．０５），芬太尼协同抑制效应不明显，但显著减慢心率（Ｐ＜０．０５）；芬太尼使插管即刻ＤＢＰ及ＨＲ的增幅低于单吸七氟醚组（Ｐ＜０．０１）。随吸入麻醉加深，ＥＥＧａｍｐ呈显著递增，合用芬太尼使插管后１．５ｍｉｎＥＭＧｆ显著低于单吸七氟醚组。结论：静注芬太尼复合七氟醚吸入有明显协同诱导效应。

Objective and Methods:Anesthesia induced by sevoflurane (sevo) or sevo+fentanyl was studied in 20 surgical patients to compare their effects on circulation, respiration, EEG,EMG and the stress response to tracheal intubation. Results:The awarenessless and painless time were shortened significantly by fentanyl ( P< 0 01). The incidence of limb movement and cough during induction also decreased by fentanyl. Sevoflurane showed a dose dependent respiratory depression with declined V T and breath frequence and such effects were not affected by fentanyl ( P> 0 05). The circulatory depression appeared at end tidal concentration of sevoflurane 1 0 and 1 3 MAC, as SBP and DBP decreased by 25% and 18% respectively ( P< 0 01). Fentanyl had no exaggerating effect, but with a decreased HR. The response of SBP, DBP, and HR to tracheal intubation was lowered by fentanyl combined with sevo ( P< 0 01). EEGf, EMGf decreased and EEGamp increased after anesthesia induction, the short time elevation of EEGf in sevo group was not seen in fentanyl+sevo group. Conclusion: the anesthesia induced by iv fentanyl+sevo inhalation offers a favorable combined effect, which is better than sevo inhalation alone.