芬太尼复合不同浓度七氟醚吸入诱导对气管插管反应的影响

Effects of Fentanyl Combined Inhalation Induction with Different Concentration of Sevoflurane on Response to Endotracheal Intubation

目的:比较肺活量吸入诱导法中不同七氟醚维持诱导浓度对气管插管反应的影响。方法:选择ASAⅠ～Ⅱ级,年龄20～50岁,将择期行腹腔镜手术的女性患者60例随机分为A、B、C三组各20例。各组诱导前静脉注射2μg·kg^(-1)芬太尼,2 min后使用肺活量法吸入8%七氟醚,意识消后失立即静脉注射0.2 mg·kg^(-1)顺式阿曲库铵,同时三组分别换用3%,5%和8%七氟醚维持诱导,面罩机械通气3 min后气管插管,使用Narcotrend监测诱导期的麻醉深度,记录诱导过程中和气管插管后意识消失的时间,气道反应及血流动力学变化。结果:(1)插管前C组MBP下降最明显,达基础值(MBPbase)的33.6%(P<0.001);(2)插管后1min,三组MBP上升至最大值,与MBPbase相比无统计学差异(P>0.05);与插管前相比,三组上升幅度为A组34.9%(P<0.01)、B组27.7%(P<0.001)和C组32.9%(P<0.01)。插管后2 min三组HR上升到最大值,与插管前比较,三组上升幅度分别为A组20.0%(P<0.01)、B组15.2%(P<0.001)和C组20.6%(P<0.01)。(3)诱导插管过程中,C组MBPmin较MBPbase下降42.2%(P<0.001),C组HRmax较HRbase升高22.3%(P<0.01)。(4)C组MBP降低<30%MBPbase和HR升高>100次/分的发生率均高于A、B组(P<0.001)。结论:芬太尼2μg·kg^(-1)复合3%、5%、8%七氟醚吸入诱导均可减轻气管插管反应,芬太尼与5%七氟醚复合诱导血流动力学最稳定。

Objective： To compare the effects of different maintenance concentration of sevoflurane on response to endotracheal intubation. Methods： 60 ASA I -11 female patients aged 20-50 years undergoing laparoscopic surgery were randomized group A, group B and group C （20 casess in each group ）. Every group received intravenous injection of 2 μg. kg-l fentanyl and then induced by vital capacity inhalation with 8% sevoflurane 2 minutes later. After loss of consciousness, 0.2 mg-kg-1 cisatraeurium was injected immediately and changed concentration of sevoflurane to 3% （group A）, 5% （group B） and 8% （group C） respectively. Tracheal intubation was performed after mechanical ventilation via a face mask for 3 minutes. Narcotrend （NCT） was used to monitoring the anesthetic depth during induction. Time of awareness loss, airway response and haemodynamics response were assessed during induction and from 1 to 5 min after endotracheal intubation. Results： （1）The decrease of MBP before tracheal intubation in group C was the most of three groups which about 33.6% compared with MBPbase （P 〈 0.001）.（2） The mean value of MBP reached the top at 1 minute after tracheal intubation in each group, but there were no significant difference compared with MBPbase, while increased by 34.9% in group A（P 〈 0.01 ）,27.7% in group B（P 〈 0.001 ） and 32.9% in group C （P 〈 0.01 ）respectively compared with the MBP before tracheal intubation. The mean value of HR in each group reached the top at 2 minutes after tracheal intubation, and increased by 20.0% in group A （P 〈 0.01）,15.2% in group B （P 〈 0.001） and 20.6% in group C （P 〈 0.01）respectively compared with HR before intubation.（3）The MBPmin of patients decreased by 42.2%（P 〈 0.001）and the HRmax increased by 22.3% （P 〈 0.01） in group C compared with their baseline.（4） The incidence of MBP〈 30% MBPbase and HR 〉 100bpm （P 〈 0.001）in group C were significantly more than those in group A and B. Conclusions： Fentanyl at 2 μg .kg-1 combined 3%, 5% and 8% sevoflurane inhaled induction could reduce the response to endotracheal intubation while fentanyl combined 5% sevoflurance provided the best hemodynamic stability during induction.