丙泊酚麻醉期间舒芬太尼与顺式阿曲库铵不同配伍剂量对气管插管反应的影响

Effects of different dosage sufentanil and cisatracurium on cardiovascular response to tracheal intubation during induction of general anesthesia

目的观察丙泊酚麻醉期间舒芬太尼与顺式阿曲库铵不同剂量伍用时的气管插管反应,探讨其最适宜的配伍诱导剂量。方法将45例慢性鼻窦炎手术患者随机均分为三组。各组全麻诱导均以丙泊酚2mg/kg缓慢注射;同时A组予舒芬太尼0.3μg/kg配伍顺式阿曲库铵0.1mg/kg、B组予舒芬太尼0.2μg/kg配伍顺式阿曲库铵0.15mg/kg、C组予舒芬太尼0.1μg/kg配伍顺式阿曲库铵0.3mg/kg。记录麻醉诱导前(T0)、气管插管前(T1)、气管插管后即刻(T2)、气管插管后1min(T3)、2min(T4)、3min(T5)、5min(T6)时的SBP、DBP和HR变化。结果与T0时比较三组的SBP、DBP在T1时明显下降(P<0.01),A组和B组T2、T3时SBP、DBP与T0时相比比较差异无统计学意义(P>0.05),C组T2、T3时的SBP、DBP明显高于T0时(P<0.05或P<0.01),A组HR在T1时较T0时明显减慢(P<0.05)。HR上升幅度C组较A组和B组明显(P<0.05或P<0.01)。B组气管插管期间血压波动幅度均较A组和C组小(P<0.05或P<0.01)。气管插管呛咳反应A组明显高于B组和C组(P<0.01)。结论在丙泊酚麻醉诱导气管插管时,舒芬太尼0.2～0.3μg/kg配伍0.15～0.2mg/kg顺式阿曲库铵可以有效的抑制气管插管时的心血管反应。

Objective To study the effects of different dosage sufentanil and cisatracurium on cardiovascular response to tracheal intubation during induction of general anesthesia.Methods Forty-five patients undergoing selective endoscopic sinus surgery were randomized into three groups （n=15）.In A-group anesthesia was performed 2mg/kg propofol combined with 0.3 μg/kg sufentanil and 0.1mg/kg cisatracurium;in B-group anesthesia was performed 2mg/kg propofol combined with 0.2 μg/kg sufentanil and 0.15mg/kg cisatracurium;in C-group anesthesia was performed 2mg/kg propofol combined with 0.1 μg/kg sufentanil and 0.2mg/kg cisatracurium.Blood pressue （BP） and heart rate （HR） were recorded before induction of anesthesia （T0）,just before intubation （T1）,just after intubation （T2）,at 1min（T3） 2min（T4）,3min （T5）,5min （T6） after intubation.Results Compared to T0,BP in three groups was significantly decreased at T1（P0.01）,BP in A-group and B-group at T2,T3 had no significant difference,but BP in C-group at T2,T3 increased significantly（P0.05 or P0.01）.HR in A-group at T1 slowed significantly difference（P0.05）.HR in C-group was significantly higher than that in A-group and B-group after intubation（P0.05 or P0.01）.The change of BP was less in B-group than that A-group and C-group（P0.05 or P0.01）.Cough reponse to tracheal intubation in A-group was higher than that in B-group and C-group obviously（p0.01）.Conclusion Using propofol combined with different dose of sufentanil and cisatracurium can suppress the cardiovascular response to tracheal during induction of general anesthesia.