雷米芬太尼对小儿心内直视手术心肺转流前血流动力学的影响

Effects of remifentanil infusion on hemodynamics before CPB in children undergoing cardiac surgery

目的观察不同剂量雷米芬太尼对小儿心内直视手术心肺转流(CPB)前血流动力学的影响。方法 75例拟行先天性心脏病矫治患儿随机均分为四个不同剂量的雷米芬太尼组和芬太尼组(F组)。麻醉诱导静注芬太尼10μg/kg、雷米芬太尼2μg/kg;麻醉维持于切皮前10 min分别静脉泵注雷米芬太尼0.5μg.kg-1.min-1(R0.5组)、1.0μg.kg-1.min-1(R1.0组)、1.5μg.kg-1.min-1(R1.5组)、2.0μg.kg-1.min-1(R2.0组)和静注芬太尼10μg/kg(F组)。记录麻醉前(T0)、插管后2 min(T1)、切皮后2min(T2)、劈胸骨后2 min(T3)的HR、MAP及各组开胸后到CPB前间羟胺的使用例数情况。结果五组血流动力学在T0～T3时基本稳定。与F组比较,T3时R0.5、R1.0组HR明显增快(P<0.05),R2.0组MAP降低(P<0.05)。开胸后R2.0组间羟胺使用率(60%)明显高于F组(20%)(P<0.05)。结论输注雷米芬太尼0.5～1.5μg.kg-1.min-1能维持心内直视手术CPB前小儿的血流动力学稳定。

Objective To evaluate the effects of remifentanil infusion on hemodynamies before CPB in children undergoing cardiac surgery. Methods Seventy-five children （1-12 years old） undergoing selective cardiac surgery were randomly allocated into 5 groups with 15 cases each. The patients in group F were injected fentanyl 10 μg/kg before skin incision after fentanyl 10 μg/kg injected for anesthesia induction. The patients in 4 remifentanil groups were given remifentanil infusion in the dose of 0. 5 （group R0.5 ）, 1.0 （group R1.0 ）, 1.5 （group R1.5 ）or 2. 0（group R2.0 ）μg·kg^-1·min^-1 for the maintetence of anesthesia after a bolus injectionof 2 μg/kg for inductioru Heart rate and mean artery pressure were recorded before induction（T0 ）,at 2 min after intubation（T1 ） ,2 min after incision（T2 ） ,and 2 min after thoractomy（Ta ）. At the same time, the frequency of metaraminol use was recorded before CPB. Results The hemodynamic parameters were generally stable at T0- T3 in all groups. Heart rate was higher in groups of R0. 5 and R1.0 thanthat in group F（P〈0. 05）. The frequency of metaraminol use in group R2.0 significantly increased as high as 60%. Conclusion The hemodynamics can be kept stable by infusion of remifentanil 0. 5-1. 5μg·kg^-1·min^-1 in children undergoing cardiac surgery.