摘要
目的：观察咪唑安定、依托咪酯麻醉诱导时,伍用不同剂量的雷米芬太尼对气管内插管血流动力学的影响.方法：选择45例（ASA Ⅰ～Ⅱ）全身麻醉的患者,先依次静注咪唑安定、依托咪酯、罗库溴铵,再给予雷米芬太尼.根据雷米芬太尼剂量不同随机分为三组：Ⅰ组：缓慢静注（30s以上）雷米芬太尼0.5μg·kg^-1后泵注0.25μg·kg^-1·min^-1维持;Ⅱ组缓慢静注雷米芬太尼1μg·kg^-1后泵注0.5μg·kg^-1·min^-1维持;Ⅲ组缓慢静注雷米芬太尼1μg·kg^-1后泵注0.25μg·kg^-1·min^-1维持.1min后气管内插管.观察并记录基础值（T0）、插管前（T1）、插管即刻（T2）、插管后1min（T3）、3min（T4）、5min（T5）和10min（T6）各时点的SBP、DBP、MAP、HR和SPO2.结果：与基础值相比,三组患者诱导后SBP、DBP、MAP和HR较基础值均有所下降（P＜0.05）,需要干预的低血压,三组依次为1、3、2例,心动过缓为0、2、1例,各点组间比较无显著差异性（P＞0.05）.插管后Ⅰ组的SBP和HR较插管前显著上升（P＜0.01）,并持续到插管后3min（P＜0.05）;Ⅱ、Ⅲ组插管后较插管前血压和HR均无明显升高（P＞0.05）,但与基础值相比,Ⅱ组插管后3min HR出现明显减慢（P＜0.01）,5min后SBP、DBP、MAP出现明显降低（P＜0.05）;Ⅲ组插管后5min HR出现减慢（P＜0.05）,但减慢次数小于Ⅱ组（P＜0.05）,未达到心动过缓的标准,血压未出现明显降低.结论：在使用咪唑安定、依托咪酯、罗库溴铵诱导时,雷米芬太尼首次剂量1μg·kg^-1并加0.25μg·kg^-1·min^-1维持可有效预防气管插管时的心血管反应,且不良反应少,为气管插管诱导时较为合理的剂量.
Objective：To study the effects of remifentanil on hemodynamics during endotracheal intubation. Methods：45 adult patients （ASA Ⅰ- Ⅱ） were induced by midazulam, etomidate, rocuronium and remifentanil. According to the dose of remifentanil, the patients were divided into 3 groups in a randomized double blind fashion with Group Ⅰ （ n = 15 ） ： remifentanil 0.5μg/kg bolus （ over 30s） followed by 0.25μg · kg^-1 · min^-1 ;Group Ⅱ （n = 15） ： remifentanil 1 μg· kg bolus followed by 0.5μg · kg^-1 ·min^-1 ; Group Ⅲ （n=15）： remifentanil 1μg · kg^-1 bolus followed by 0.25μg · kg^-1 · min^-1. 1 minute later, patient was intubated. SBP, DBP, MAP, HR and SPO2 were recorded at the time points of before anaesthesia（ T0 ）, before intubation（ T1 ）, during intubation（ T2 ）, at lmin（T3） ,3min（T4 ） ,5min（T5 ） and 10min（T6 ） after intubation. Result： In Group Ⅰ , SBP and HR index showed a significant increase （P 〈 0.01 ） during intubation, and maintanted to 3 minutes later（ P 〈 0.05）. In Group Ⅱ and Ⅲ, no significant changes occurred in BP and HR（ P 〉 0.05） during intubation. But in comparison with the preanaesthesia values, in Group Ⅱ , HR decreased obviously（ P 〈 0.01 ）3 min after intubation, SBP, DBP and MAP dropped down（ P 〈 0.05 ）5 min after intubation. In Group Ⅲ, HR also decreased（ P 〈0.05）5min after intubation （but less than Group Ⅱ ） ,and BP remained unchanged. Conclusion： When induced by midazolam, etomidate and rocuronium, the hemodynamics can be kept stable with remifentanil 1 μg/kg bolus followed by 0.25μg · kg^-1 ·min^-1.
出处
《赣南医学院学报》
2006年第2期183-185,共3页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
