异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响  

Effects of different doses of remifentanil on cardiovascular response to tracheal intubation in patients during induction of anesthesia with propofol

作　　者：王竹梅[1] 安裕文[1] 杨志军[1] 邓尼惠[1] 姚丽[1] 李桂英[1] 

机构地区：[1]贵阳医学院附属医院麻醉科,550004

出　　处：《中华麻醉学杂志》2006年第7期602-604,共3页Chinese Journal of Anesthesiology

摘　　要：目的比较异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响,寻找瑞芬太尼复合异丙酚气管插管的合适剂量。方法择期行腹腔镜胆囊切除术病人36例, ASAⅠ或Ⅱ级,年龄20-65岁,随机分为3组(n=12):瑞芬太尼1、1．5、2μg／kg分别为复合异丙酚1．5 mg／kg组(Ⅰ、Ⅱ、Ⅲ组)。依次静脉注射咪唑安定0．03 mg／kg、异丙酚1．5 mg／kg、维库溴铵0．1 mg／kg以及瑞芬太尼麻醉诱导,2 min后气管插管,进行机械通气,呼吸频率12次／min,潮气量8-10 ml／kg,维持呼气末二氧化碳分压35～45 mm Hg。持续监测血压(平均动脉压、舒张压、收缩压)、心率(HR)以及听觉诱发电位指数(AAI),并记录病人有无气管插管时呛咳和肌肉强直、术中知晓等反应。结果与基础值比较,三组气管插管前即刻血压及Ⅲ组气管插管后即刻舒张压均降低,Ⅲ组气管插管后即刻血压低于Ⅰ组(P<0．05);HR组间及组内比较差异无统计学意义;三组间AAI差异无统计学意义。结论异丙酚1．5 mg／kg麻醉诱导期间瑞芬太尼1或1．5μg／kg是病人气管插管时的合适剂量。Objective To determine the appropriate dose of remifentanil during induction of general anesthesia with propofol according to cardiovascular response to intubation and auditory evoked potential index （AAI） .Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 20-65 yrs undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly divided into 3 groups （n = 12 each） according to remifentanil doses-1.0 （ Ⅰ ）, 1.5 （ Ⅱ ） and 2.0 （ Ⅲ ）μg·kg^-1. Anesthesia was induced with midazolam 0.03 mg ·kg^-1, propofol 1.5 mg·kg^-1 and vecuronium 0.1 mg·kg^-1. Remifentanil was injected Ⅳ immediately after vecuronium over 60-90 seconds. Tracheal intubation was performed at 2 min after remifentanil injection. BP（ SBP, DBP and MAP） and AAI were continuously monitored during anesthesia and recorded immediately before induction （T0, baseline）, immediately before intubation （T1）, immediately and 1, 2, 3 min after intubation （T2.3, 4.5 ）. Results SBP, DBP and MAP decreased significantly at T1 as compared to the baseline values at T0 in the 3 groups. SBP, DBP and MAP were significantly lower at T2 （immediately after intubation） in group Ⅲ than in group Ⅰ. AAI decreased significantly after induction of anesthesia as compared to the baseline. There was no significant difference in HR and AAI among the 3 groups. Conclusion Remifentanil 1.0 or 1.5 μg·kg^-1 is the appropriate dose during induction of anesthesia with propofol （ 1.5 mg·kg^-1）.

关 键 词：哌啶类 二异丙酚 插管法 气管内 

分 类 号：R614[医药卫生—麻醉学]