Narcotrend指导下对比瑞芬太尼和芬太尼对经口气管插管全麻手术患儿血压和心率的影响

Effects of remifentanil and fentanyl on blood pressure and heart rate in children undergoing general anesthesia via orotracheal intubation guided by Narcotrend

目的:在麻醉/脑电意识监测系统(Narcotrend)指导下,比较瑞芬太尼和芬太尼联合丙泊酚全麻诱导时对经口气管插管患儿血压和心率的影响。方法:选择进行经气管插管全麻手术患儿60例,年龄3~10岁,美国麻醉医师协会分级Ⅰ级,随机分为瑞芬太尼组(R组)和芬太尼组(F组)。丙泊酚静脉泵注,待Narcotrend指数(NI)在D2~E1时,静脉注射顺式阿曲库铵0.2 mg/kg,R组给予瑞芬太尼2μg/kg,F组给予芬太尼3μg/kg,随后在可视喉镜下经口气管插管。调整丙泊酚输注速度,使NI维持在D2~E1。监测患儿入室后基础值(T1)、麻醉诱导用药后(T2)、插管即刻(T3)和插管后1、3、5、7 min(T4、T5、T6、T7)的血压和心率;记录NI首次达D2~E1时丙泊酚输注量。结果:R组患儿在T3~T5的心率、T3~T4的血压均低于F组,差异均有统计学意义(均P<0.05)。结论:丙泊酚联合瑞芬太尼2μg/kg较芬太尼3μg/kg能更有效的抑制经口气管插管全麻诱导对患儿血压和心率的影响。

Objective:To compare the effects of remifentanil and fentanyl combined with propofol on blood pressure and heart rate in children undergoing general anesthesia via orotracheal intubation guided by Narcotrend.Methods:Sixty children undergoing general anesthesia via orotracheal intubation,aged 3 to 10 years,grade I,American Society of Anesthesiologists,were randomly divided into remifentanil group(R group)and fentanyl group(group F).Propofol was injected intravenously,when the Narcotrend Index(NI)was D2-E1,intravenous cis-atracurium 0.2 mg/kg,and R group was given remifentanil 2μg/kg,group F was given Fentanyl 3μg/kg,and then intubated via a orotracheal tube under glidescope.The infusion rate of propofol was adjusted to keep NI between D2 and E1.Blood pressure and heart rate were monitored at the baseline values(T1),after induction of anesthesia(T2),immediately after intubation(T3)and 1,3,5,7 minutes after intubation(T4,T5,T6,T7).The amount of propofol infusion when NI reaches D2-E1 for the first time was recorded.Results:The heart rate of T3-T5 and the blood pressure of T3-T4 were lower in group R than those in group F,and the difference has statistical significance(P<0.05).Conclusion:Propofol combined with remifentanil 2μg/kg was more effective than propofol combined with fentanyl 3μg/kg to inhibit the effects of general anesthesia induced by oral tracheal intubation on blood pressure and heart rate in children.