摘要
目的：观察不同血浆靶浓度瑞芬太尼复合丙泊爵时．在老年人不使用肌松药所提供的气管插管条件和心血管反应。方法：36例择期手术老年病人。髓机分为3组．血浆耙浓度2ng／ml组、3ng／ml组和4ng／ml。靶控输注瑞芬太尼5min后．开始靶控输注丙泊爵（2．5μg／m1）。10min后进行气管插管，失败则增加瑞芬太尼靶控浓度1ng／ml，10min后重复。再次失败则退出本研究。在瑞芬太尼输注前，丙泊酚开始输注时．置入喉镜前即刻以及插管后1min。分别记录气管插管评分、平均动脉压和心率。同时记录不良反应和血管活性药物的使用。结果：第一次插管评分。2ng／ml组．3ng／ml组及4ng／ml组分别为10．4±2．7，7．7±2．4和5．8±1．0；第一次播管成功率分别为7／12（52％）．10／12（83％）和12／12（100％）；前两组第二次擂管成功率分别为2／5（40%）和1／2（so％）。各组心率均有下降，以3ng／ml和4ng／ml组尤其明显；动脉压显著下降则见于4ng／ml组。2ng／ml组病人插管后较插警翦相比心率与血压有明显升高。高浓度瑞芬太尼组需用血管活性药物比倒增加。结论：老年病人固定丙泊酚TCI血浆浓度2．5μg／ml，不使用肌松帮时．瑶芬太尼3～4ng／ml血浆浓度可基本满足插管条件。随瑞芬太尼TCI浓度增加。插管成功率提高。但同时心率减慢发生率也明显上升。
Objective： To observe the tracheal intubation conditions and hemodynamic changes during remifentanil target controlled infusion （TCI） at different plasma concentrations combined with propofol. Methods： Thirty-six patients were randomly allocated into three groups. Remifentanil were given using TCI at plasma concentration of 2 ng/ml, 3ng/ml and 4ng/ml in each group respectively and after 5-min remifentanil infusion, propofol was given with TCI at plasma concentration 2.5μg/ml. Ten minutes later, inserting laryngoscope and tracheal intubation were tried and intubation conditions were recorded. If failed, the remifentanil concentration was increased by 1 ng/ml and once more intubation was tried ten minutes later. The heart rate and blood pressure at baseline, after remifentanil infusion, before intubation and one minute after intubation were recorded. Meanwhile, the intubation scores and side effects during induction were recorded. Results： The intubation scores at first attempt were 10.4±2.7,7.7±2.4 and 5.8±1.0 in three groups, and success ratio were 7/12 （ 52% ） , 10/12（83%） and 12/12（100%）, respectively. The ratio in the second attempt were 2/5（40%） and 1/2（50%） in two low dose groups. Blood pressure was reduced following infusion of remifentanil at 4 ng/ml. Heart rates were lowered significantly, especially in 3-4ng/ml groups. Compared with pre-intubation, heart rate and blood pressure in 2ng/ml group were significantly increased after intubation. However, atropine and adrenaline were more administered in the high concentration group. Conclusion： Combined with propofol TCI at 2.5μg/ml, tracheal intubation may be facilitated by remifentanil TCI at 3-4 ng/ml. Tracheal intubation successful rate may be elevated with increasing plasma concentrations of remifentanil, but heart rates be also lowered down significantly.
出处
《麻醉与监护论坛》
2006年第5期255-257,共3页
Forum of Anesthesia and Monitoring
关键词
老年人
丙泊酚
瑞芬太尼
气管插管
心血管反应
Remifentanil
Propofol
Tracheal intubation
Cardiovascular response
Elder
