不同剂量瑞芬太尼对全麻诱导期气管插管血流动力学的影响

Effects of different doses remifentanil on hemodynamic responses to tracheal intubation

目的观察复合异丙酚下不同剂量瑞芬太尼对全麻诱导期气管插管时血流动力学的影响,探索瑞芬太尼全麻诱导期气管插管的较佳剂量。方法将60例患者随机分为4组,对照组诱导给予芬太尼,其它3组诱导给予不同剂量的瑞芬太尼,其余诱导药物一致,待患者意识消失后,行气管内插管。观察从入室到插管后5分钟之内的HR、SBP、DBP、MAP。结果瑞1组SBP、MAP值在插管后1min、2min时均有较大的升高,与其余3组组间相比差异有统计学意义(P<0.05);R2和R3组从插管插入即刻起,血压开始回升,而R2组血压回升平稳,T3、T4、T5、T6比较差异无统计学意义。结论瑞芬太尼1μg/kg单次静脉注射诱导不能很好的抑制插管后心血管应激反应。与瑞芬太尼2μg/kg对比,1.5μg/kg剂量诱导可以很好的抑制插管后心血管应激反应。

Objective To investigate the effect of different dose remifentanil combined with propofol on trachea intubation hemodynamic changes during induction of general anesthesia,and to optimize a better dosage of remifentanil during this phase. Methods Sixty ASA physical status I -II patients, undergoing major surgery,were randomly assigned to 4 groups, and then the compared group administer fentanil , the other groups administer different dose of remifen tanil,the trachea was intubated 60s after the medicine infusion. Intubation condition and hemodynamic changes in trachesl intubation were observed. Note HR.SBP.DBP.MAP in the time of after the patients in the operating room,induction,after intubation in 5 min. Results After intubation 1 rain,2 min, SBP.MAP of R1 group were largely increased,and compared with the other 3 groups the difference between groups was statistically significant （P〈0.05）; In R2 and R3 groups,the blood pressure began to rise immediately from the tube inserted, still below the level before anesthesia,and blood pressure rise steadily in R2 group, compared between with T3, T4, T5, T6 was no significant difference. Conclusion Single administered intravenous dosage 1 μg/kg of remifentanil can not effectively inhibit cardiovascular responses. Compared Remifentanil 2.0 μg/kg group, the dosage 1. 5 μg/kg and single intravenous dose can induce good cardiovascular stress response after intubation. The dosage 1.5 μg/kg is ideal dose during tracheal intubation.