七氟醚与丙泊酚复合瑞芬太尼麻醉对儿童心率变异性的影响  

Changes of heart rate variability in children with sevoflurane versus propofol-remifentanil anesthesia

作　　者：李晓红[1] 刘洋[1] 李巍[1] 徐子龙[1] 邵贵骞[1] 孟丽巍[1] 

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2011年第5期470-473,共4页Journal of Harbin Medical University

基　　金：黑龙江省教育厅科学技术研究项目(11531221)

摘　　要：目的比较眼科手术七氟醚与丙泊酚复合瑞芬太尼麻醉对儿童心率变异性的影响。方法择期全麻下行眼科手术患儿60例,年龄4～10岁,性别不限,随机分为七氟醚组(S组)与丙泊酚复合瑞芬太尼组(PR组),每组30例。麻醉诱导相同,咪达唑仑0.05 mg.kg-1,芬太尼3μg.kg-1,丙泊酚2mg.kg-1,置入喉罩。麻醉维持:S组吸入七氟醚,呼气末浓度设定为1.0 MAC。PR组瑞芬太尼0.10μg.kg-1.min-1复合丙泊酚10 mg.kg-1.min-1恒速输注,两组术中均未使用肌松药,均手术结束前5min停药。观察两组患儿麻醉前(T0)、麻醉诱导后(T1)、喉罩置入即刻(T2)、手术开始即刻(T3)、手术5min(T4)、10 min(T5)、15 min(T6)、30 min(T7)各时间点收缩压、舒张压、心率、脑电双频谱指数及心率变异性指标总功率(TP)、低频功率(LF)、高频功率(HF)、低频功率/高频功率(LF/HF)的变化。结果与T0时比较,两组在T1时TP、LF、HF、LF/HF降低(P<0.05);T2时TP、LF、LF/HF升高(P<0.05或P<0.01),HFnu降低(P<0.05);T4～T7时,TP、LF、HF降低(P<0.05或P<0.01)。与S组比较,PR组在T3～T7时TP、LF、HF升高(P<0.05或P<0.01),LF/HF降低(P<0.05或P<0.01)。结论七氟醚与丙泊酚复合瑞芬太尼麻醉均使儿童自主神经张力降低。丙泊酚复合瑞芬太尼麻醉抑制副交感神经程度小于抑制交感神经程度,导致副交感神经占优势。Objective To observe the changes of heart rate variability（HRV） in children with sevoflurane versus propofol-remifentanil anesthesia performed ophthalmic surgery.Methods Sixty children of both sexes aged 4~10 years old undergoing ophthalmic surgery were randomly divided into 2 groups（n=30 each）： group sevoflurane（group S） and group propofol-remifentanil（group PR）.Anesthesia was induced with midazolam 0.05 mg.kg-1,fentanil 3 μg·kg-1,propofol 2 mg·kg-1 in both groups,then largngeal mask（LMA） was inserted.In group S,anesthesia was maintained with sevoflurane which enspired concentration kept at 1.0 MAC.Five minutes before the surgery finished,sevoflurane inhalation was stopped.In group PR,remifentanil was infused at 0.10 μg·kg-1·min-1 and propofol was infused at 10 mg·kg-1·min-1.Muscle relaxant was not used in neither group.Remifentanil and propofol was stopped 5 minutes before the end of the surgery.SBP,DBP,HR,Total power（TP）,Low frequency（LF）,High frequency（HF） and LF/HF were monitored before anesthesia（T0）,after induction（T1）,when laryngeal mask（LMA） was inserted（T2）,when operation begins（T3） and 5（T4）,10（T5）,15（T6）,30（T7）minutes after the operation.Results In both groups,TP、LF、HF、LF/HF were decreased at T1 and were increased at T2（P0.05 or P0.01）;TP、LF、HF were decreased at T4-T7（P0.05 or P0.01）.Compared with group S,TP、LF、HF were higher and LF/HF was lower at T3-T7 in group PR（P0.05 or P0.01）.Conclusion Both sevoflurane and propofol-remifentanil anesthesia decrease autonomic nervous activity.Propofol-remifentanil anesthesia reduces parasympathetic tone to a lesser degree than sympathetic tone resulting in parasympathetic dominance.

关 键 词：七氟醚 二异丙酚 心率变异性 儿童 喉罩 

分 类 号：R614.2[医药卫生—麻醉学]