不同剂量芬太尼在全身麻醉诱导中对心率变异性和脑电双频指数的影响

Influence of different dose of fentanyl on heart rate variability and eeg double-frequency index during general anesthesia induction

目的观察全身麻醉诱导期间不同剂量芬太尼对患者心率变异性（HRV）和脑电双频指数（BIS）的影响,确定芬太尼可有效抑制气管插管所致心血管反应的最佳剂量。方法选择美国麻醉医师协会Ⅰ~Ⅱ级全身麻醉下行腹部手术的患者30例,随机分成3组,分别注射芬太尼3μg.kg-1（Ⅰ组）、5μg.kg-1（Ⅱ组）、7μg.kg-1（Ⅲ组）。各组诱导均用异丙酚1.0 mg.kg-1,维库溴胺0.1 mg.kg-1,咪达唑仑0.1 mg.kg-1,缓慢静脉注射。给予芬太尼5 min后气管插管,观察麻醉诱导前（基础值）、诱导后气管插管前、气管插管即刻、插管后1、3、5 min时BIS、95%边缘频率（SEF）、HRV、收缩压（SBP）、收缩压（DBP）、心率（HR）的变化。结果诱导后3组SBP、DBP、HR值均下降,诱导后各个时间点Ⅲ组的SBP、DBP和HR值均明显低于Ⅰ组和Ⅱ组（P〈0.05）;3组各个时间点脑电BIS与95%SEF均明显低于基础值（P〈0.01）;气管插管后5min,Ⅲ组的脑电BIS与95%SEF值均低于Ⅰ组和Ⅱ组（P〈0.05）;诱导后3组低频（LF）、高频（HF）均下降（P〈0.05,P〈0.01）,诱导后Ⅱ组、Ⅲ组LF、LF/HF值明显低于Ⅰ组（P〈0.05）,Ⅱ组与Ⅲ组LF、LF/HF值比较差别无统计学意义（P〉0.05）;3组HF值比较差别均无统计学意义（P〉0.05）。结论 5μg.kg-1芬太尼可有效抑制气管插管所致的心血管反应。

Objective To observe the influence of different dose of fentanyl on heart rate variability（HRV）and bispectral index（BIS） during general anesthesia induction,and to determine the optimal dose of fentanyl for active suppression in cardiovascular effects caused by tracheal intubation.Methods Ⅰ-Ⅱ American Society of Anesthesiologists（ASA）30 patients,undergoing elective operation on abdominal region in general anesthesia were randomly divided into three groups,fentanyl 3,5,7 μg·kg-1 was used respectively in group Ⅰ,Ⅱ,Ⅲ by intravenous injection.Anesthesia induction was performed with a combination of propofol 1.0 mg·kg-1,vecuronium bromide 0.1 mg·kg-1,midazolam 0.2 mg·kg-1 intravenously.BIS,95% spectral edge frequency（SEF）,HRV,systolic blood pressure（SBP）,diastolic blood pressure（DBP） and heart rate（HR） were studied before induction（fundamental data）,pre-intubation after induction,at the moment of induction and at 1,3,5 minutes after intubation.Results After induction,SBP,DBP and HR decreased in three groups,SBP,DBP and HR in group Ⅲ were obviously lower than these in group Ⅰ and Ⅱ at the any moment（P0.05）,BIS and 95%SEF values were significantly lower than fundamental data（P0.01） in three groups at any moment.Five minutes after endotracheal intubation BIS and 95%SE values in the group Ⅲ were significantly lower than these in the group Ⅱ and group I（P0.05）.LF and HF decreased after induction in three groups（P0.05,P0.01）;LF and LF/HF in the group Ⅲand groupⅡ were lower than that in group I（P0.05）;But LF and LF/HF between the group Ⅲ and groupⅡ had no significant difference（P0.05）;The difference of HF among the three groups had no statistical significance（P0.05）.Conclusion The dose of 5 μg·kg-1 fentanyl can effectively inhibit the cardiovascular effects caused by tracheal intubation.