不同剂量的芬太尼对冠心病患者全身麻醉诱导应激反应的影响  

Influence of different doses of Fentanyl on stree response during induction of anesthesia on coronary heart disease patients

作　　者：韩启民[1] 

机构地区：[1]河南省中医院,河南郑州450002

出　　处：《中国现代医学杂志》2009年第7期1065-1067,共3页China Journal of Modern Medicine

摘　　要：目的观察不同全身麻醉诱导方式对冠心病患者气管插管过程中的血流动力学变化及听觉诱发电位指数(AAI)的影响。方法ASAⅡ、Ⅲ级择期手术的30例冠心病患者,据诱导药物不同随机分为3组(每组10例),分别为:Ⅰ组:用咪唑安定0.1mg/kg、异丙酚1.0mg/kg、芬太尼3μg/kg、维库溴铵0.1mg/kg;Ⅱ组:用咪唑安定0.1mg/kg、异丙酚1.0mg/kg、芬太尼4μg/kg、维库溴铵0.1mg/kg;Ⅲ组用咪唑安定0.1mg/kg、异丙酚1.0mg/kg、芬太尼6μg/kg、维库溴胺0.1mg/kg。3组患者分别记录诱导前时(T0)、诱导后3min(T1)、唯镜显露声门时(T2)、气管导管插入气管内时(T3)的MAP、HR、AAI。结果与T0相比:T1、T2时,各组血压、心率均显著下降;T3时,Ⅰ组血压、心率显著升高;Ⅱ组心率显著升高。与Ⅰ组各时点相比:Ⅱ组AAI显著下降,各时点血压均显著下降,T2时心率显著升高;Ⅲ组AAI显著下降,T2时心率显著升高;T3时,心率、血压显著下降。Ⅲ组与Ⅱ组相比:Ⅲ组患者T1、T2、T3时的血压均显著升高;Ⅲ组患者的T3时的心率显著下降。结论冠心病患者在麻酸诱导时应做到:麻醉诱导要有一定的麻醉深度;麻醉诱导时可加大芬太尼的用量。[Objective] To compare the effects of different doses of Fentanyl on haemodynamic and auditory evoked potential index （AAI） during induction of anesthesia. [Metheds] Thirty CHD patients （ASA Ⅱ-Ⅲ） were randomly assigned into three groups according to different doses of Femanyl： Group Ⅰ （Midazolam 0.1 mg/kg, Propofol 1.0 mg/kg, Fentartyl 3 μg/kg, Vecuronlum 0.1 mg/kg）; group n （Midazolam 0.1 mglkg, Propofol 1.0 mg/kg, Fentartyl 4μg/kg, Veeuronium 0.1 mg/kg）,group Ⅲ （Midazolam 0.1 mg/kg, Propofol 1.0 mg/kg, Fentartyl 6 p,g/kg, Vecuronium 0.1 mg/kg）. The venous outcome were taken to measure the MAP, HR, AAI, before induetion（T0）, at 3 minutes after intubafion （T1）, When laryngoscopy revealed supraglottie （T2）, when insert endotraeheal intubation （T3）. [Resuits] There was a significant reduetion in BP and HR in T1 and T2 eompared with TO; intubation was associated with inereaseing BP and HR in group Ⅰ and an increaseing HR Ⅱ in T3. Compared with group Ⅰ ： group II＇s AAI, BP were declined, HP increased in T2; patients＇ AAI in group Ⅲ were declined, HR increased in T2; BP, HR were declined in T3. Group Ⅲ had a significant inereasing BP in T1, T2, T3 compared with group Ⅱ and declined HR in T3. [Conclusion] During induction of anesthesia on coronary heart disease patients： Have a certain degree of depth of induction of anaesthesia; May increase the dosage of Fentanyl.

关 键 词：全身麻醉 气管内插管法 血流动力学 听觉诱发电位 芬太尼 咪唑安定 

分 类 号：R614.2[医药卫生—麻醉学]