心率变异性分析在瑞芬太尼对无肌松气管插管中自主神经活动性的影响中的应用  

Application of heart rate variability in effect of remifentanil on autonomic nerve activity during tracheal intubation without muscle relaxation

作　　者：苏丽明[1] 申岱[2] 刘建[3] SU Liming;SHEN Dai;LIU Jian(Tianjin Third Central Hospital Branch,Tianjin 300250,China;不详)

机构地区：[1]天津市第三中心医院分院,天津300250 [2]天津医科大学口腔医院 [3]天津市第三中心医院

出　　处：《山东医药》2020年第10期13-17,共5页Shandong Medical Journal

基　　金：天津市自然科学基金项目(16JCQNJC11612)。

摘　　要：目的采用心率变异性法,探究瑞芬太尼对无肌松气管插管中自主神经活动性的影响。方法选择择期全麻下行甲状腺肿物切除术患者46例,采用随机法分为两组(n=23):瑞芬太尼组(R组)和顺式阿曲库铵组(C组)。麻醉方法:R组使用瑞芬太尼2μg/kg缓慢静脉注射,而C组使用顺式阿曲库铵0.1 mg/kg、芬太尼4μg/kg静脉注射。选择四个采样点,即基础状态(T0)、诱导(T1)、插管(T2)、插管后5 min(T3)。对所选的四个信号进行时域性分析[RR间期的标准差(SDNN)、相邻RR间期差的均方根(RMSSD)]、频域分析[总功率(TP)、高频功率(HF)、低频功率(LF)]、非线性分析[Poincare散点图的短轴(SD1)、散点图的长轴(SD2)],同步记录上述各时段对应的心率(HR)、平均动脉压(MAP)和脑电双频指数(BIS)值,再对所有分析结果进行统计学处理。结果①与T0、T1、T2时比较,T3时两组HR明显降低;T2、T3时R组HR明显低于C组(P均<0.05)。与T0时比较,T1、T2、T3时两组MAP和BIS值明显降低(P<0.05),R组T1、T2时的MAP和T1、T2、T3时的BIS值明显低于C组(P<0.05)。②两组各时段SDNN、lgTP、LF/HF、SD2的变化基本一致:与T0时比较,T1、T2时两组升高(P均<0.05);与T1时比较,T2时两组和T3时R组降低(P均<0.05);与T2时比较,T3时两组降低(P均<0.05)。与T0时相比,R组T1时和两组T3时RMSSD明显降低(P均<0.05)。结论心率变异性分析结果提示,在无肌松气管插管时使用瑞芬太尼,可以完全满足气管插管的临床条件,但在麻醉诱导时交感神经活动明显受抑制。Objective To investigate the effect of remifentanil on autonomic nerve activity during tracheal intubation without muscle relaxation by heart rate variability(HRV).Methods Forty-six patients for elective thyroidectomy under general anesthesia were randomly divided into two groups(n=23):remifentanil group(group R)and cisatracurium group(group C).Anesthesia methods:remifentanil 2μg/kg was used in the group R,while cisatracurium 0.1 mg/kg and fentanyl 4μg/kg were used in the group C.There were four sampling points in this experiment:basic state(T0),induction(T1),intubation(T2),and 5 minutes after intubation(T3).The four selected signals were analyzed in time domain[standard deviation(SDNN)of RR interval,root-mean square of adjacent RR interval difference(RMSSD)],frequency domain[total power(TP),high frequency power(HF),low frequency power(LF)],and nonlinear analysis[short axis(SD1)of Poincare scattergram,long axis(SD2)of scattergram],and the corresponding heart rate(HR),mean arterial pressure(MAP)and bispectral index(BIS)values of the above periods were recorded simultaneously,and then all the analysis results were statistically processed.Results(1)Compared with T0,T1 and T2,HR of the two groups decreased significantly at T3,and HR of the group R was significantly lower at T2 and T3 than that of the group C(P<0.05).Compared with T0,MAP and BIS at T1,T2 and T3 in the two groups decreased significantly(all P<0.05),MAP at T1 and T2 and BIS at T1,T2 and T3 in the group R were significantly lower than those of the group C(all P<0.05).(2)The changes of SDNN,lgTP,LF/HF and SD2 in each period of the two groups were basically the same:compared with T0,they increased significantly at T1 and T2(all P<0.05).Compared with T1,they decreased at T2 in the two groups and at T3 in the group R(all P<0.05).Compared with T2,they decreased at T3 in the two groups(all P<0.05).Compared with T0,RMSSD decreased significantly at T1 in the group R and at T3 in the two groups(all P<0.05).Conclusion Remifentanil can completely meet the clinica

关 键 词：心率变异性 自主神经 瑞芬太尼 无肌松气管插管 甲状腺切除术 

分 类 号：R614.2[医药卫生—麻醉学]