雷米芬太尼对老年患者气管插管心血管反应的影响

Effects of remifentanil on cardiovascular response to tracheal intubation in the elderly

目的观察不同剂量雷米芬太尼微量泵输注对老年患者气管插管时的心血管反应。方法 60例全麻老年患者随机均分为六组。泵注丙泊酚33 mg/min至意识消失后,Ⅰ、Ⅱ、Ⅲ组分别输注雷米芬太尼0.15、0.20、0.25μg.kg^-1.min^-1,持续6 min;Ⅳ、Ⅴ、Ⅵ组分别输注雷米芬太尼0.15、0.20、0.25μg.kg^-1.min^-1,持续8 min。丙泊酚维持量0.12 mg.kg^-1.min^-1。雷米芬太尼输注结束时静注罗库溴铵0.6 mg/kg,气管插管。记录诱导前（T0）、气管插管前1 min（T1）、气管插管后1 min（T2）、2 min（T3）、3 min（T4）、4 min（T5）、5 min（T6）的SBP、DBP和HR变化。结果与T0时比较,T1时六组SBP、DBP明显下降、HR明显减慢（P〈0.05或P〈0.01）,T2和T4时Ⅲ、Ⅴ、Ⅵ组HR均明显减慢（P〈0.05或P〈0.01）。与T1时比较,T2-T3时Ⅰ、Ⅱ组SBP和DBP、T2-T4时Ⅳ组SBP均明显升高（P〈0.05或P〈0.01）;Ⅰ、Ⅳ、Ⅴ组T2-T6时、Ⅱ组T2-T3时、Ⅲ组T3-T6时和Ⅵ组T3-T5时的HR明显增快（P〈0.05或P〈0.01）。结论老年患者气管插管时,雷米芬太尼复合丙泊酚微量泵输注时,雷米芬太尼以0.20或0.25μg.kg^-1.min^-1的速度,泵注6 min以上可以有效地抑制气管插管时的心血管反应。

Objective To investigate the effects of different doses of remifentanil on the cardiovascular responses to tracheal intubation in the elderly.Methods Sixty gerontic surgical patients were randomized into six groups with 10 cases each.The patients were induced with propofol at a rate of 33 mg/min up to loss of conciousness,which was followed by infusion of remifentanil 0.15（group Ⅰ）,0.20（group Ⅱ） or 0.25 μg·kg-1·min-1（group Ⅲ） for 6 min and 0.15（group Ⅳ）,0.20（group Ⅴ） or 0.25 μg·kg-1·min-1（group Ⅵ） for 8 min.Rocuronium 0.6 mg/kg was injected to facilitate tracheal intubation.The blood pressure（BP） and heart rate（HR） were recorded before intubation（T0）,at 1 min before tracheal intubation（T1）,1 min（T2）,2 min（T3）,3 min（T4）,4 min（T5）,5 min（T6） after tracheal intubation.Results Compared to T0,BP and HR of six groups decreased markedly at T1（P 〈0.05 or P〈0.01）.HR of groups of Ⅲ,Ⅴ and Ⅵ was obviously lower at T2 and T4 than that at T0（P〈0.05 or P〈0.01）.SBP and DBP in groups of Ⅰ and Ⅱ at T2-T3 and SBP in group Ⅳ at T2-T4 were obviously higher than those at T1（P〈0.05 or P〈0.01）.Compared to T1,HR of groups of Ⅰ,Ⅳ and Ⅴ at T2-T6 increased significantly,so did that of group Ⅱ at T2-T3,group Ⅲ at T3-T6,and group Ⅵ at T3-T5（P〈0.05 or P〈0.01）.Conclusion Remifentanil infused at a rate of 0.20 μg·kg-1·min-1 for 6 min or more may effectively attenuate the cardiovascular response to tracheal intubation in the elderly.