瑞芬太尼与丙泊酚诱导后补注对围插管期血流动力学的影响

目的观察瑞芬太尼或丙泊酚诱导后补注对插管期心血管的稳定作用.方法拟行气管插管全麻患者227例,ASA分级Ⅰ～Ⅱ级,麻醉诱导后SBP下降<30%者187例,随机分为A,B,C三组,A组63例,B,C组各62例.用瑞芬太尼1μg/kg、丙泊酚1.5 mg/kg、维库溴铵0.1 mg/kg静脉注射诱导,2 min后A组直接气管插管,B,C组分别补注瑞芬太尼0.2μg/kg和丙泊酚诱导剂量的1/5,随后行气管插管,观察并测量三组气管插管完成时即刻(T1)、3 min(T2)、5 min(T3)的HR,SBP,DBP,并计算RPP;比较3组插管后4项指标的变化,并与基础值(T0)比较.结果与T0时相比,A组插管后T1,T2时的HR,SBP,RPP均明显增加(P<0.05),而B,C两组插管后T1,T2时HR,SBP,RPP与T0时比较差异无统计学意义(P>0.05);与A组比较,B,C两组插管后T1时的HR,SBP,RPP均明显下降(P<0.05),而B组T1时的DBP与A组比较差异无统计学意义(P>0.05);B,C两组间各时点HR,SBP,RPP比较差异无统计学意义(P>0.05);T3时A,B,C三组的HR,SBP,DBP,RPP及与T0时比较差异无统计学意义(P>0.05).结论诱导后补注适量的瑞芬太尼或丙泊酚均可有效减轻气管插管时的心血管反应,对有高血压/缺血性心脏病的患者丙泊酚较瑞芬太尼更利于心肌灌注.

Effect of Supplementary Injection of Remifentan after the Induction of Propofol on Hemodynamics during Pre-Postintubation Period

Objective To observe the stabilizing effect of remifentanil or supplementary injection of it after the induction of propofol on cardiovascular system.Method 187 cases of 227 patients who were going to undergo general anesthesia through tracheal intubation were selected,in which ASA grading were in class Ⅰ~Ⅱand the declining of systolic blood pressure(SBP)were <30% after induction of anesthesia,and were randomly divided into three groups,63 cases in group A,62 cases in group B and C respectively.The anesthesia was induced with intravenous injection of 1 μg/kg remifentanil,1.5 mg/kg propofol,and 0.1 mg/kg vecuronium;2 minutes later,patients in group A were given tracheal intubation,and those in group B and group C were respectively given the supplementary injection of 0.2 ug/kg remifentanil and one-fifth of the induced propofol dose,followed by tracheal intubation;then,HR,SBP and DBP were monitored at the immediate moment of tracheal intubation completion(T1),3min(T2)and 5 min(T3)after the intubation in three groups,and RPP was calculated;differences in the four values after the intubation among 3 groups were compared and also with the basic values(T0).Results Compared with those at T0,HR,SBP,DBP at T1 and T2 after intubation in group A increased significantly(P<0.05),but HR,SBP,RPP at T1 and T2 after intubation in group B and C were not significantly different(P>0.05);compared with those in group A,HR,SBP,RPP at T1 after intubation in group B and C decreased significantly(P<0.05),while compared with that in group A,DBP at T1 in group B was not significantly different(P>0.05);HR,SBP and RPP at each time point in group B and C were not significantly different(P>0.05);compared with those at T0,HR,SBP,DBP and RPP at T3 in group A,B and C were not significantly different(P>0.05).Conclusion A supplementary injection of suitable dose of remifentanil or propofol after the induction would alleviate the cardiovascular response to the tracheal intubation effectively;comparing with remifentanil,propofol is more conducive to the myocardial perfusion in patients with hypertension or ischemic heart disease.