瑞芬太尼复合依托咪酯靶控输注心脏瓣膜置换术麻醉诱导观察

Remifentanil target-controlled infusion of etomidate during induction of anaesthesia of cardiac valve replacement

目的 观察瑞芬太尼复合依托咪酯靶控输注在心脏瓣膜置换手术麻醉诱导时对血流动学的影响.方法 选取择期行心脏瓣膜置换手术病人46例,ASAⅡ～Ⅲ级,性别不限,年龄36 ～ 73岁,体重42 ～ 85kg,随机分为2组（n=23）,诱导开始时,静脉输注咪唑安定0.03 mg·kg-1,Ⅰ组诱导采取靶控输注血药浓度：瑞芬太尼5～6 ng/ml,依托咪酯0.6 μg/ml;Ⅱ组采取静脉单次缓慢注射的方式,瑞芬太尼1～1.5 μg·kg-1,依托咪酯0.3～0.6 mg·kg-1,意识消失后静脉注射维库溴铵0.15～0.2 mg·kg-1,肌松满意后实施气管内插管.记录诱导前、插管前、插管时、插管后1 min、2 min各时间点的HR、SBP、SDP、MAP、SP02的变化值及血管活性药物（麻醉碱、阿托品、佩尔地平、艾司洛尔）使用情况.结果 两组病人诱导后血压、心率有明显下降,与基础值比较差异显著（P＜0.05）;Ⅱ组血流动力学下降甚于Ⅰ组,差异明显（P＜0.05）;Ⅱ组病人插管时及插管后1 min血压、心率波动大,与基础值及Ⅰ组比较,差异显著（P＜0.05）,使用血管活性药物例数明显超过Ⅰ组;Ⅰ组诱导至插管后1 min内,血压下降较基础值明显,但较为平稳;2 min时两组趋于一致,无显著性差异.结论 瑞芬太尼复合依托咪酯用于心脏瓣膜置换手术的麻醉诱导时,靶控输注方式对血流动力学的影响小,优于单次静脉注射.

Objective To observe the effect of etomidate combined with remifentanil target - controlled infusion in the induction of anesthesia in cardiac valve replacement operation is to study the influence of blood flow. Methods 46 patients undergoing elective cardiac valve replacement operation patients,ASA II - 111 grade, gender, age 36 - 73 years old,weighing 42 - 85 kg, were randomly divided into 2 groups （ n = 23 ）, induction, intravenous infusion of midazolam 0.03 mg · kg^- 1, group I induced by target controlled infusion of remifentanil concentration ： 5 - 6ng/ ml, etomidate 0.6μ g/ml;group II take a single intravenous injection way slowly, remifentanil 1 - 1.5 μg · kg^-~, etomidate 0.3 - 0.6 mg · kg ^- 1, lost consciousness after intravenous vecuronium 0.15 - 0.2 mg· kg^ -1, satisfactory muscle relaxation effect after endotracheal intubation. Before induction, intubation, intubation, intubation changes after 1 minutes ,2 minutes each time point of HR, SBP, SDP, MAP, SPO2 value and vasoactive drugs （ anesthesia atropine, alkali, Pell horizon, esmolol） use. Results In the two groups after the induction of blood pressure, heart rate decreased significantly, compared with the baseline values differ significantly （P 〈 0.05 ） ; group II hemodynamics decreased than group I , significant difference （ P 〈 0.05 ） ; group 11 patients intubated and intubation after 1 minutes of blood pressure, heart rate variability, compared with the basic values and group I , significant difference （P 〈 0.05 ）, The use of vasoactive drugs were significantly more than in group I ; in group I was induced within I rain after intubation, blood pressure decreased significantly compared with the basic value, but is relatively stable; 2 minutes two groups tend to be consistent, no significant difference. Conclusion Remifentanil combined with etomidate used in induction of anesthesia in cardiac valve replacement operation time, target controlled small effects on hemodynamics infusion, is better than a single intravenous injectio.