摘要
目的评价不同速率输注瑞芬太尼对老年患者气管插管反应的影响。方法 30例择期行上腹部手术老年患者,随机分为3组(n=10),麻醉诱导开始时,分别静脉输注瑞芬太尼0．05μg· kg-1·min-1(R0．05组)、0．10μg·kg-1·min-1(R0．10组)、0．15μg·kg-1·min-1(R0．15组),10 min后静脉注射咪唑安定0．1 mg·kg-1,意识消失后静脉注射琥珀酰胆碱1．5 mg·kg-1,行气管插管,于输注瑞芬太尼前、气管插管前即刻、气管插管后即刻、气管插管后2、5、10min记录血压(BP)、心率(HR),并于各时点采静脉血检测肾上腺素(E)、去甲肾上腺素(NE)水平;记录各组肌僵、低血压等副反应的发生情况。结果 R0．05组气管插管反应的发生率(80％)高于R0．10组(10％)和R0．15组(10％)。R0．15组肌僵、血压下降和心动过缓等副反应的发生率高于R0．10组。R0．05组气管插管后2、5、10 min及R0．10 组气管插管后2、5 min NE、E浓度均高于基础值,且高于R0．15组;R0．15组气管插管后2、5 min NE浓度高于基础值,E浓度差异无统计学意义。结论老年患者静脉输注瑞芬太尼诱导气管插管的合适速率为0．10μg·kg-1·min-1。
Objective To evaluate the effects of different rates of remifentanil infusion on cardiovascular response to tracheal intubation in older patients. Methods Thirty ASA Ⅰ -Ⅲ patients aged 65-75 yrs weighing 50- 80 kg scheduled for elective abdominal operation were randomly divided into 3 groups （ n=10each） according to the remifentanil infusion rate ： group A 0.05 μg·kg^-1·min^-1 ; group B 0.1μg·kg^-1·min^-1 and group C 0.15 μg·kg^-1·min^-1. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Radial artery and subclavian vein were cannulated for BP and CVP monitoring and blood sampling. ECG, BP, HR and SpO2 were monitored during anesthesia. After 10min stabilization induction of anesthesia was commenced with remifentanil infusion for 10 min. Midazolam 0.1 mg·kg^-1 was then given Ⅳ. Succinylcholine 1.5 mg· kg^-1 was given to facilitate intubation after the patients lost consciousness. BP and HR were recorded immediately before induction of anesthesia （To, baseline）, immediately after intubation （T1） and at 2, 5 and 10 min after intubation （T2 ,T3 ,T4 ） . Cardiovascular intubation response was defined as increase in SP or HR by 15% of the baseline value within 2 min after intubation. Blood samples were taken at To 4 for determination of plasma concentration of norepinephrine （NE） and epinephrine （E） by HPLC. Side effects such as chest wall rigidity and hypotension were also recorded. Results The cardiovascular intubation response rate was significantly higher in group A （80%） than in group B （10%） and C （10%）. The incidence of side effects was significantly higher in group C （70%） than in group B （20%） and A. Plasma NE and E concentrations were significantly increased after intubation in group A （at T2-4） and B （at T2-3 ） as compared with baseline values at To; while in group C only plasma HE concentration was significantly increased at T2 and T3 and there was no significant change in plasma E concentration after intubation. The plasma NE and E concentrations were significantly higher in group A （T2-4） and B （ T2-3 ） than in group C. Conclusion The appropriate infusion rate of remifentanil for tracheal intubation is 0.10 μg·kg^-1·min^-1 in older patients.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第2期114-117,共4页
Chinese Journal of Anesthesiology
基金
河南省卫生厅资助项目(20050088)
关键词
哌啶类
应激
老年人
插管法
气管内
Piperidines
Stress
Aged
Intubation,intratracheal
