心率变异性指导围插管期芬太尼应用的研究

Effects of different doses of fentanyl on heart rate variability during tracheal intubation in elderly patients with coronary artery disease

目的通过评价与分析心率变异性,了解不同剂量芬太尼对老年冠心病患者自主神经功能的影响,以确定芬太尼的最佳诱导剂量。方法 45例择期行上腹部手术老年冠心病患者,ASAⅡ、Ⅲ级,随机分为3组（n=15）,麻醉诱导开始时,缓慢静脉推注丙泊酚1.0~1.5 mg/kg,当意识和睫毛反射消失后,静推维库溴胺0.1mg/kg,并分别缓慢推注不同剂量的芬太尼3μg/kg（F 3.0组）,5μg/kg（F 5.0组）,7μg/kg（F 7.0组）,行气管插管。于麻醉前基础值、气管插管前即刻、插管后即刻、插管后5和10 min记录收缩压（SP）、舒张压（DP）、心率（HR）及心率变异性（HRV）,并记录各组肌僵、呛咳、低血压等副反应的发生情况。结果 3组病人的一般情况、基础值比较差异无显著性（P〉0.05）,3组病人在插管前即刻SP、DP、HR和HRV均显著低于基础值（P〈0.05）;插管前后比较仅F3组SP、DP、HR和HRV明显高于插管前即刻（P〈0.05）,F5和F7组比较差异无显著性（P〉0.05）;F3组气管插管反应的发生率高于F5组和F7组,F7组肌僵、呛咳、血压下降和心动过缓等副反应发生率高于F5组。结论芬太尼5μg/kg静脉注射诱导能有效抑制老年冠心病患者插管操作引起的对植物神经功能的影响,并能明显地抑制心血管反应,使血流动力学相对平稳,可安全而有效的应用于老年冠心病患者的麻醉诱导。

【Objective】To evaluate the effects of different doses of fentanyl on cardiovascular response and heart rate variability（HRV） during tracheal intubation in elderly patients with coronary artery disease.【Methods】Fortyfive ASA Ⅱ ~ Ⅲ patients with coronary artery disease aged 60 ~80 yrs weighing 45 ~80 kg, scheduled for elective surgery were randomly divided into 3 groups（n =15） according to the doses of fentanyl： group F3; group F5; group F7. ECG, invasive BP, HR and HRV were monitored before and during anesthesia. Anesthesia were induced by propofol1-1.5 mg/kg, fentanyl（group F3 3 μg/kg; group F5 5 μg/kg; group F7 7 μg/kg）, vecunium 0.1 mg/kg intravenous injection after the patients lost consciousness. All these drugs were injected by vein. Tracheal intubation was performed 5 minutes after vecunium injection. BP, HR and HRV were recorded immediately before induction of anesthesia（baesline）, immediately after intubation and at 5 and 10 min after intubation. Side effects such as chest wall rigidity and hypotension were also recorded. 【Results】There were no statistical differences among the three groups with respect to sex, age, weight, height, type of operation, preoperation blood pressure, HR and HRV. In the three groups all of the BP, DP, HR and HRV were significantly lower than the baseline after induction but before intubation（P 0.05）, SP, DP, HR and HRV were significantly higher in group F3 than in group F5 and F7 after tracheal intubation（P 0.05）, while there were no statistical differences between group F5 and F7（P 0.05）. The cardiovascular intubation response rate was significantly higher in group F3 than in group F5 and F7. The incidence of side effects was higher in group F7 than in group F3 and F5. 【Conclusion】Fentanyl 5 μg/kg could inhibit the cardiovascular response and the interference with autonomic function caused by tracheal intubation in general anesthesia. It is beneficial to maintain cardiac autonomic nerve function to elderly patients with coronary artery disease during intubation.