摘要
目的研究比较瑞芬太尼与芬太尼在全麻诱导过程中对患者应激反应的影响。方法选择择期全麻手术患者60例,分为瑞芬太尼(R)组和芬太尼(F)组,每组30例。调节丙泊酚使脑电双频指数(BIS)保持在50以下。记录所有患者入室后(T0)、诱导后插管前(T1)、插管即刻(T2)、插管后3 min(T3)、插管后5 min(T4)、插管后10 min(T5)的MAP、HR、BIS等指标,分别于T0、T3、T4、T5四个时间点测血浆中肾上腺素(E)和去甲肾上腺素(NE)水平。结果两组麻醉诱导后患者的MAP、HR均有下降(P<0.05),组间无统计学意义(P>0.05),但气管插管后血流动力学变化幅度R组明显小于F组(P<0.05);两组气管插管后的血清肾上腺素、去甲肾上腺素水平均高于基础值(P<0.05),T3、T4、T5三个时间点测的肾上腺素、去甲肾上腺素水平R组低于F组(P<0.05)。结论瑞芬太尼和芬太尼均能较好地抑制气管插管所造成的应激反应,但瑞芬太尼较芬太尼能更好地抑制插管引起的血压波动,维持循环系统稳定。
Objective To compare the effect of fentanyl and remifentanil on stress reaction during induction. Methods Sixty patients undergoing selective operation with total intravenous anaesthesia were randomly divided into 2 groups..R group and F group. Bispectral index （BIS） was controlled under 50 by giving propofol. MAP, HR and BIS of all patients were recorded at entering operating room （To）,the instant before tracheal intubation （T1） and after tracheal intubation （T2）, at 3 min （T3）, 5 min （T4）and 10 rain （T5） after tracheal intubation. The concentrations of adrenaline, noradrenaline were measured at To, T3, T4, TS. Results MAP and HR in two groups at preintubatton were lower than baseline with no significance. Hemodynamic changes during intubation were significantly fewer in R group than in F group （P〈0.05）. The levels of adrenaline and noradrenaline in the blood were higher than those before the operation （P〈0. 05）. Besides, at 3min（T3）, 5 rain （T4） and 10 rain （T5） after tracheal intubation, the contents of adrenaline and noradrenaline in the F group were increased significantly than those in R group （P〈0. 05）. Conclusion Remifentannil and fentanyl could restrain stress reaction induced by tracheal intubation, but remifentanil could restrain fluctuation of blood pressure induced by tracheal intubation better than fentannyl for maintaining the balance of circulation system.
出处
《西部医学》
2009年第5期812-813,共2页
Medical Journal of West China
