普鲁泊福复合不同剂量瑞芬太尼应用于非肌松剂气管插管的观察  

Observation of propofol combined with different dose of remifentanil in tracheal intubation, without the use of muscle relaxants

作　　者：傅海青[1] 

机构地区：[1]浙江省舟山医院麻醉科,316000

出　　处：《中国医师进修杂志》2011年第15期9-11,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 观察普鲁泊福麻醉诱导时复合不同剂量瑞芬太尼应用于非肌松剂气管插管时对患者心血管反应的影响.方法 将60例ASA分级Ⅰ～Ⅱ级的非心、脑外科择期全身麻醉手术患者按随机数字表法分为Ⅰ、Ⅱ、Ⅲ组,每组20例,注射泵输注瑞芬太尼血浆靶控浓度分别为2、3、4ng/ml,输注5 min后开始靶控输注普鲁泊福（血浆靶控浓度3μg/ml）.记录三组患者诱导前（T1）、普鲁泊福开始即刻（T2）、气管插管前即刻（T3）、气管插管后1 min（T4）的平均动脉压（MAP）、心率变化,以及气管插管评分和第1次插管成功率.结果 Ⅰ、Ⅱ、Ⅲ组气管插管评分分别为（10.5±2.9）、（7.6±2.3）、（5.8±1.2）分,第1次插管成功率分别为50%（10/20）、80%（16/20）、100%（20/20）,三组间比较差异均有统计学意义,Ⅲ组均优于Ⅰ组和Ⅱ组（P＜0.05）.T2与T1比较,Ⅱ组和Ⅲ组心率均显著减慢（P＜0.05）,Ⅲ组更明显;T4与T3比较,Ⅰ组和Ⅱ组心率显著增快,Ⅰ组明显高于Ⅱ组和Ⅲ组（P＜0.05）.T3与T2比较,三组MAP均显著下降;T4与T3比较,Ⅰ组MAP显著上升,且高于Ⅱ组和Ⅲ组（P＜0.05）.结论 在不使用肌松剂时,普鲁泊福复合瑞芬太尼靶控浓度3～4 ng/ml能较好地抑制气管插管的应激反应,而又不引起明显的循环抑制,对维持麻醉诱导插管过程的平稳较为有利.Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml （group Ⅰ ）, 3 ng/ml （group Ⅱ ） and 4 ng/ml （group Ⅲ）. Target-controlled infusion of propofol after infusion of remifentanil for 5 min （3 μg/ml of plasma target concentration）. The mean arterial pressure （MAP）,heart rate （HR）, intubation conditions and success rate of patients in different groups before induction（T1）, at the beginning moment of propofol（T2）,at the immediate moment before tracheal intubation （T3） and at the time of 1 min after tracheal intubation （T4）. Results The grade of tracheal intubation was （10.5 ±2.9）, （7.6 ±2.3）, （5.8 ± 1.2） scores and the success rate of the first intubation was 50%（ 10/20）, 80%（16/20）, 100%（20/20） in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups （P〈 0.05）,group Ⅲ was superior to group Ⅰ and Ⅱ （P〈0.05）. Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly （ P 〈 0.05）, and in group Ⅲ slowed down more significantly （P〈0.05）. Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ （P〈 0.05）. Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ （P 〈 0.05）. Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and

关 键 词：二异丙酚 导管插入术 外周 瑞芬太尼 麻醉诱导 心血管反应 

分 类 号：R614[医药卫生—麻醉学]