小剂量瑞芬太尼对舒芬太尼全身麻醉诱导插管反应的干预效果

Intervention effect of small dose remifentanil on sufentanil induction of general anesthesia intubation response

目的评价小剂量瑞芬太尼对舒芬太尼全麻诱导插管反应的干预效果。方法采用双盲、随机对照研究。选择ASAⅠ-Ⅱ级,年龄21-60岁,体质量40-90 kg,需在气管插管全身麻醉下行手术的患者40例,按随机数字表分观察组（瑞芬太尼＋舒芬太尼组）和对照组（舒芬太尼组）,每组20例。麻醉诱导：顺序注射咪唑安定2 mg、舒芬太尼0.3μg/kg、丙泊酚1-2 mg/kg、罗库溴铵0.6-0.9 mg/kg和瑞芬太尼（体质量〈60 kg用25μg、体质量≥60 kg用50μg）合并注射,各药间隔1 min,距末次注药1-1.5 min（即诱导开始后5 min）用可视喉镜行气管插管。记录诱导前（T0）、插管前（T1）、插管后1 min（T2）、插管后3 min（T3）和插管后5 min（T4）的平均动脉压（MAP）和心率（HR）,观察声带运动等不良反应及用药处理情况,评价插管成功率。结果与T0时间点比较,观察组与对照组T1-4时间点MAP显著下降（P〈0.01）,对照组T2-3时间点HR显著增加（P〈0.01,0.05）;与对照组比较,观察组T2-3时间点HR显著下降（P〈0.05）。两组均未发生声带运动,插管成功率均为100%;观察组心动过速发生率显著低于对照组（P〈0.05）。结论小剂量瑞芬太尼对舒芬太尼全身麻醉诱导插管反应有明显干预效果,在有效保持BP尤其是HR稳定同时,获得插管条件优不良反应少的临床效果。

Objective To evaluate intervention effect of small dose remifentanil on sufentanil induction of general anesthesia intubation response. Methods Taken the double-blind, randomized, controlled study. Forty ASAI -II level patients with tracheal intubation general anesthesia downlink surgery aged 21 to 60 years old, 40 to 90 kg were chosen, according to random number table points, patients were divided into observation group （remi-fentanil and sufentanil group） and control group （sufentanil group）, with 20 cases in each group. Anesthesia induction： sequential injection infidazole 2 mg, sufentanil 0. 3 μg/kg, propofol 1 -2 mg/kg, rocu-roninm bromide 0. 6 -0. 9 mg/kg and remifentanil （weight 〈60 kg with 25μg, weight I〉60 kg with 50 μg） combined injection, the interval of 1 rain, 1 - 1.5 rain away from the last note medicine （that is, the induced after the first 5 rain） with visual laryngoscope endotracheal intubation. Recorded before induction （T0）, before intubation （T1） , 1 rain after intubation （T2）, 3 min after intubation （T3） and 5 min after intubation （T4） MAP and HR, observed the vocal cord movement and other adverse reactions and drug treatment, and evaluated the success rate of intubation. Results Compared with TO time points, TI - 4 point MAP of observation group and control group decreased significantly （ P 〈 0. 01 ）, T2 - 3 point HR of control group increased significantly （ P 〈 0. 01,0. 05 ） ; Compared with the control group, T2 - 3 point HR of observation group decreased significantly （ P 〈 0. 05 ）. There were not vocal cord movement in the two groups, intubation success rate was 100%. Tachycardia incidence of observation group was significantly lower than that of control group （P 〈 0. 05 ）. Conclusion Small dose remifentanil for sufentanil induction of general anesthesia intubation response has obvious intervention effect, it can effectively maintain the BP especially HR stability at the same time to obtain the clinical effect of intubation conditions optimum less adverse reaction.