七氟醚麻醉下不同剂量舒芬太尼对气管插管时应激反应的影响

Influence of sulfentanil with various doses on the stress response during the tracheal intubation under the anestheaia of sevoflurane

目的观察在七氟醚麻醉下,不同剂量舒芬太尼对气管插管时应激反应的影响。方法 80例妇科患者,ASAⅠ-Ⅱ级,年龄20-49岁,全麻下行择期腹腔镜手术,随机分为A、B、C、D四组(n=20)。予8%七氟醚吸入诱导(氧流速为6L/min),待患者意识消失后,B、C、D组复合应用舒芬太尼,剂量分别为0.25μg/kg、0.5μg/kg、1.0μg/kg,A组给予生理盐水2ml,静注罗库溴铵0.6mg/kg,待七氟醚呼气末浓度上升至2.0MAC时,维持2min后行气管插管。记录麻醉诱导前(t0)、患者意识消失时(t1)、气管插管前(t2)、气管插管后1min(t3)、气管插管后3min(t)4的脑电双频指数(BIS)值和血流动力学。结果 B组心率(HR)在气管插管后1min(t3)、气管插管后3min(t4)均高于麻醉诱导前(t0),差异有统计学意义(P<0.05);D组平均动脉压(MAP)在气管插管后1min(t3)、气管插管后3min(t4)均低于麻醉诱导前(t0),差异有统计学意义(P<0.05);气管插管后BIS的最高值(tmax)在A、B、C三组均高于气管插管前(t2),BIS值的上升程度(气管插管后的最大值-插管前数值)随舒芬太尼剂量的增大而减小,差异有统计学意义(r2=0.445,P<0.05)。结论七氟醚麻醉下,0.5μg/kg舒芬太尼可有效抑制气管插管时的应激反应。

Objective To observe the influence of sufentanil with various doses on the stress response during the tracheal incubation under the anesthesia with sevoflurane.Methods 80 ASAⅠ-Ⅱpatients undergoing gynecological operations were randomly divided into four groups：Group A：placebo,Group B：sufentanil 0.25 μg/kg,Group C：0.5μg/kg,Group D：1.0μg/kg,all injected intravenous when the patients lost consciousness.The hemodynamic values and bispectral index were recorded in the time pots of pre-induction,loss of consciousness（LOC）,pre and post tracheal intubations.Results The values of HR post-tracheal incubation in the group B were higher than those pre-induction,and the values of MAP post-tracheal incubation in the group D were lower than those pre-induction.The indices of bispectral in all groups were all significantly lower in the time pots of the LOC and pre-tracheal incubation than those pre-induction（P0.05）,the tendency of the bispectral index rising was decreasing with the increasing dose of sufentanil during the tracheal incubation（P0.05）.Conclusion Under the anesthesia of sevoflurane,sufentanil with the dose of 0.5μg/kg can effectively prohibit the stress response during the tracheal incubation.