瑞芬太尼或氯胺酮预先给药对减轻依托咪酯注射后肌颤的疗效观察  

The effect of remifentanil versus ketamine pretreatment on etomidate induced myoclonus

作　　者：王一如 刘洪君 沈霞 WANG Yi ru;LIU Hong jun;SHEN Xia(Department of Anesthesiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031

出　　处：《复旦学报（医学版）》2018年第5期712-715,734,共5页Fudan University Journal of Medical Sciences

摘　　要：目的观察瑞芬太尼或氯胺酮预先给药对降低依托咪酯注射后肌颤发生的有效性。方法 75例ASAⅠ～Ⅱ级择期行中耳显微手术的成年患者,随机分为对照组(C组,生理盐水,n=25)、瑞芬太尼组(R组,瑞芬太尼0.5μg/kg,n=25)给药和氯胺酮组(K组,氯胺酮0.5 mg/kg,n=25)。给药1 min后注射依托咪酯0.3 mg/kg。记录依托咪酯注射后2 min内肌颤发生情况;记录以下各时间点的心率和血压变化:麻醉前(T_0)、预先给药后1 min(T_1)、依托咪酯注射后2 min(T_2)、罗库溴铵注射后1 min(T_3)、喉罩置入后即刻(T_4);记录呼吸抑制和罗库溴铵注射痛等不良事件。结果瑞芬太尼组患者肌颤发生率和严重程度最低,氯胺酮不能降低肌颤的发生(P=0.004 8);时间和分组交互作用显示血压(P=0.030 7)和心率变化(P=0.0494)差异有统计学意义;瑞芬太尼导对呼吸的抑制程度最显著(P<0.000 1);瑞芬太尼和氯胺酮均降低罗库溴铵注射痛(P<0.000 6)。结论瑞芬太尼0.5μg/kg预先给药可有效降低依托咪酯引起的肌颤和罗库溴铵注射痛,对循环和呼吸有抑制作用。氯胺酮0.5 mg/kg预先给药不能降低依托咪酯引起的肌颤,可减轻罗库溴铵注射痛。Objective To observe the efficacy of remifentanil or ketamine pretreatment for reducing etomidate induced myoclonus. Methods Seventy five adult patients of ASA Ⅰ-Ⅱ who underwent elective middle ear surgery were randomly divided into 3 groups：control group （group C, normal saline, n 25） ,relnifentanil group （group R,relnifentanil 0.5 μg/kg,n=25） and ketamine group （group K, ketamine 0.5 mg/kg,n=25）. Etomidate of 0.3 mg/kg was injected 1 minute after administration. The incidence and severity of myoclonus were assessed for 2 minutes after etomidate injection. Mean arterial pressure （MAP） and heart rate （HR） were recorded before anesthesia induction （T0）, 1 minute after pretreatment （T1） ,2 minutes after etomidate injection （T2）, 1 minute after rocuronium injection（T3 ） and after laryngeal mask airway insertion （T4）. Adverse events including respiratory suppression and rocuronium injection pain were also noted. Results Incidence and intensity of myoclonus were both significantly reduced in group R, but not in group K, when compared with group C （P=0. 004 8）.Interaction between time and group showed that changes of MAP （P 0. 0307） and HR （P=0. 049 4） among 3 groups were both significantly different. More patients in group R suffered apnea （P〈0. 000 1）. Remifentanil and ketamine both attenuated rocuronium injection pain （P〈0. 000 6）. Conclusions Remifentanil rather than ketamine pretreatment was effective to reduce etomidate induced myoclonus, but caused more changes in hemodynamic profiles and respiratory depression.

关 键 词：依托咪酯 肌颤 阿片类 不良事件 

分 类 号：R614.21[医药卫生—麻醉学]