大剂量瑞芬太尼抑制丙泊酚麻醉下儿科患者的窦房传导和窦房结自律性

背景本研究旨在探讨瑞芬太尼对行射频导管消融术儿科患者的窦房结功能和心房一希氏束间期的影响。方法前瞻性纳入60例患有预激综合征的儿科患者。全麻诱导后持续输注丙泊酚维持麻醉。麻醉平稳后记录计算的窦房传导时间（calculatedsinoatrialconductiontime，CSACT）、校正的窦房结恢复时间（correctedsinusnoderecoverytime，CSNRT）和心房一希氏束间期（AH间期），并比较中等剂量（0．2μg·kg-1。·min-1）和大剂量（0．4μg·kg-1·min-1）瑞芬太尼输注前和输注期间的数据。数据以均数（95％可信区间）表示。结果中等剂量的瑞芬太尼延长了CSNRT[给药后由177（117～237）毫秒延长到245（167～322）毫秒；P=0．016]，但不影响CSACT（P=0．59）和心房一希氏柬间期（P=0．11）。而大剂量的瑞芬太尼延长CSNRT[给药后由201（144～260）毫秒延长到307（232～382）毫秒；P=0．019]和CSACT[给药后由48（31～65）毫秒延长到78（59～96）毫秒；P=0．038]，但不影响心房一希氏束间期（P=0．058）。瑞芬太尼不同剂量对CSNRT的影响没有差异（P=0．44）。结论瑞芬太尼可能抑制心房内传导和窦房结自律性，但对房室结传导没有影响。在0．2／μg·kg-1·min-1到0．4／μg·kg-1·min-1输注速率范围内没有观察到剂量依赖性。

BACKGROUND： We sought to determine the effect of remifentanil on sinus node function and the atrial-His （AH） interval in pediatric patients undergoing radiofrequency catheter ablation. METHODS： Sixty pediatric patients with Wolff-Parkinson-White syndrome were prospectively enrolled in this study. General anesthesia was induced and maintained with a continuous infusion of propofol. We recorded the calculated sinoatrial conduction time （CSACr）, corrected sinus node recovery time （CSNRT）, and AH interval when the patients were in a stable anesthetic state and compared the values before and during remifentanil administration at a moderate dose （0.2 μg · kg- 1· min-1 1 ） or a high dose （0.4μg · kg -1 · min - 1 ）. Data are expressed as mean （95% confidence interval）. RESULTS： At the moderate dose, remifentanil prolonged CSNRT （from 177 [ 117 -237] milliseconds to 245 [ 167 -322 ] milliseconds after administration; P = 0.016）, but had no effect on either CSACT （P = 0. 59） or AH interval （P = 0. 11 ）. However, high-dose remifentanil prolonged both CSNRT （from 201 [ 144 -260] milliseconds to 307 [232 - 382 ] milliseconds after administration; P = 0. 019） and CSACT （from 48 [ 31 - 65 ] milliseconds to 78 [59 -96] milliseconds after administration; P = 0. 038）, but had no effect on the AH interval （P = 0. 058）. The interaction in CSNRT between remifentanil administration and its dose was not different （P = 0.44）. CONCLUSIONS： Remifentanil may inhibit both intraatrial conduction and sinus node automaticity, but it has no effect on conduction through the atrioventricular node. Dose dependency was notobserved within the range of 0.2 to 0.4μg · kg-1·min-1 of remifentanil.