芬太尼和瑞芬太尼对老年患者依托咪酯肌阵挛的预防作用

Preventive effect of fentanyl and remifentanil on myoclonus induced by etomidate in elderly patients

目的研究芬太尼和瑞芬太尼预处理在老年患者依托咪酯气管插管全麻诱导中对肌阵挛发生及血流动力学参数剧烈波动的预防作用。方法选取择期行全麻气管插管手术患者90例,年龄〉65岁,ASAⅠⅡ级,按随机数字法分为芬太尼组（F组）、瑞芬太尼组（R组）和生理盐水组（C组）,每组30例。麻醉诱导开始静脉注射0.2 mg/kg依托咪酯前,C组注射生理盐水10 mL,F组注射芬太尼3.0μg/kg,R组给予瑞芬太尼2.0μg/kg,注射时间至少30s,随后R组0.3μg/（kg·min）持续泵注,记录肌阵挛的发生情况和严重程度。待患者意识消失,睫毛反射消失,BIS值低于50,注射顺式阿曲库铵0.2 mg/kg后2 min进行气管插管。记录基础值（T0）、诱导即刻（T1）、插管即刻（T2）及插管后1 min（T3）、3 min（T4）的MAP、HR。结果 F组、R组及C组的肌阵挛发生率分别为10%、3.3%、50%。F组、R组发生肌阵挛的频率和严重程度均显著低于C组（P〈0.05）,而F组与R组比较差异无统计学意义（P〉0.05）。气管插管后,R组血流动力学的稳定性优于其他两组（P〈0.05）。结论 3.0μg/kg芬太尼和2.0μg/kg瑞芬太尼均可降低老年患者依托咪酯全麻诱导期引起的肌阵挛发生率和严重程度,而2.0μg/kg瑞芬太尼预处理在麻醉诱导期可起到更好的血流动力学作用。

Objective To study the preventive effect of fentanyl and remifentanil on myoclonus and serious hemodynamic change induced by etomidate during general anesthesia in elderly patients.Methods Ninety patients（ASA ⅠⅡ,〉65 years old） who underwent elective surgery with general anesthesia were randomly divided into 3groups：fentanyl group（group F）,remifentanil group（group R） and normal saline group（group C）.Patients were injected with etomidate（0.2 mg/kg） before induction of anesthesia,and group C was injected with normal saline 10 mL group F was injected with fentanyl 3.0 μg/kg,and group R was injected with remifentanil 2.0 μg/kg.The injection time was at least 30 s.The incidence and intensity of myoclonus was observed.Patients were injected with 0.2 mg/kg cisatracurium besylate when the consciousness was lost and the eyelash reflex disappeared with BIS index less than50,and the endotracheal intubation was given at 2 min after injection.The MAP and HR at baseline（T0）,O h after induction（T1） p min（T2）,1 min（T3） and 3 min（T4） after intubation.Results The incidences of myoclonus in group F group R and group C were 10%3.3%and 50%respectively.The frequency and intensity of myoclonus in group F and group R were lower than those of group C（P 〈 0.05）.There was no significant difference in the frequency and intensity of myoclonus between group F and group R（P 〉0.05）.The stability of hemodynamic parameters after intubation in group R was better than those of group F and group C.Conclusion Both fentanyl（3.0 μg/kg） and remifentanil（2.0 μg/kg） can reduce the incidence and intensity of myoclonus induced by etomidate injection in elderly patients.Pretreatment with remifentanil 2.0 μg/kg can provide stable hemodynamic parameters in elderly patients injected with etomidate.