瑞芬太尼抑制气管插管应激反应的量效关系

Effect of different dose Remifentanyl on the stress reaction response in the peri-endotracheal intubation

目的观察不同剂量瑞芬太尼抑制气管插管应激反应的量效关系。方法 50例ASAⅠ～Ⅱ气管插管全麻患者,根据麻醉诱导瑞芬太尼剂量的不同:0.5、1.0、1.5、2.0、2.5μg/kg随机分为5组(每组10例),即Ⅰ～Ⅴ组。记录建立静脉通路30min(a)、插管前(b)、插管即刻(c)、插管后1min(d)、插管后5min(e)五个时点平均动脉压(MAP)、心率(HR)、BIS的变化,插管后1min抽血测血清皮质醇。结果随着瑞芬太尼剂量的增加,血清皮质醇浓度逐渐降低(P<0.05)。组内与a时点比较,c、d时点Ⅰ、Ⅱ组HR、MAP明显升高(P<0.01),Ⅳ、Ⅴ组明显降低(P<0.01),Ⅲ组无明显变化(P>0.05)。与Ⅲ组比较,c、d时点Ⅰ、Ⅱ组HR、MAP、BIS升高(P<0.05),Ⅳ、Ⅴ组降低(P<0.05)。结论瑞芬太尼1.5μg/kg能很好地抑制气管插管反应,并保持血流动力学稳定。

Objective To investigate the effect of different dose remifentanyl on stress reaction during end tracheal intubation. Methods 50 ASA physical status Ⅰ-Ⅱ patients accepting general anesthesia were randomly assigned to five groups （ n = 10 per group）. Remifentanyl 0. 5,1.0,1.5,2. 0 and 2. 5μg/kg were in- jected in Group Ⅰ-Ⅴ separately during end tracheal intubation. The mean blood pressure （MAP）, heart rate （HR） and Bispeetrial index （BIS） were reordered on five different times （a：after lactated Ringer＇s solution 5 ml/kg was infused, b ： before tracheal intubation, c ： tracheal intubation, d ： 1 min after tracheal intubation, e ： 5 minute after tracheal intubation）, and the plasma concentration of cortical 1 min after tracheal intubation were measured. Results The plasma concentration of cortical decreased when remifentanyl increased （ P 〈 0. 05 ） Compared with time a, MAP and HR in group Ⅰ and Ⅱ raised （ P 〈 0. 01 ） and reduced in group Ivand Ⅴ （ P 〈 0. 01 ） significantly on time c and d. Compared with group m, MAP, BIS and HR in groupⅠ and Ⅱ raised （ P 〈 0. 05） and reduced in group Ⅳ and Ⅴ （ P 〈 0. 05 ） significantly on time c and d. Conclusion 1.5 μg/kg remifentanyl can depress the stress reaction sufficiently and maintain the homodynamic stable.