【摘要】 目的探讨靶控输注不同浓度雷米芬太尼预防依托咪酯诱导时肌阵挛的效果及对血流动力学的影响。方法 120例美国麻醉师协会(ASA)Ⅰ～Ⅱ级择期全麻手术病人,靶控输注前静脉注射0.03mg/kg咪唑安定,按雷米芬太尼的血浆靶浓度随机分为4组(R0、R2、R4、R6组),即0、2、4、6ng/ml组,达到效应室平衡后5min,给予依托咪酯0.3mg/kg静脉诱导,病人意识消失后静注罗库溴铵行气管插管,观察血流动力学变化与肌阵挛的发生率及强度。结果靶控输注雷米芬太尼2ng/ml以上明显减少依托咪酯诱导时肌阵挛的发生率。R0、R2和R4组插管后1min及2min的平均动脉压(MAP)和心率(HR)均高于插管前(P<0.05),而R6组插管后1min及2min的MAP和HR与插管前比较差异无统计学意义(P>0.05)。结论靶控输注雷米芬太尼2ng/ml以上即能有效抑制依托咪酯诱导时的肌阵挛,靶控输注雷米芬太尼6ng/ml复合依托咪酯能有效抑制诱导时的肌阵挛与气管插管时的应激反应。更多还原

【Abstract】 Objective To compare the effects of remifentanil in various target plasma concentrations on myoclonus and hemodynamic response during etomidate induction. Methods 120 American Society of Anesthesiologists(ASA)Ⅰ～Ⅱ patients undergone elective surgery under general anesthesia were enrolled in this study.Before TCI each group received midazolam 0.03 mg/kg intravenous injection.The patients were randomly divided into 4 groups to receive remifentanil at a fixed target plasma concentration of 0,2, 4, and 6 ng/ml (group R0, R2, R4, R6). General anesthesia was then induced with etomidate 5 minutes later. Trachea was intubated after intravenous rocuronium when the consciousness of patients was lost. The number and classification of patients who experienced myoclonus in each group and the changes of MAP and HR were monitored in the induced process and after intubation. Results Pretreatment with TCI remifentanil (2,4,6 ng/ml) significantly reduced myoclonus movements after etomidate administration (P<0.05). MAP and HR increased significantly for 2 minutes after intubation in group R0, R2 and R4, but MAP and HR did not change in group R6 after intubation. Conclusion Pretreatment with TCI remifentanil at 2 ng/ml or >2 ng/ml can significantly reduce the occurrence of etomidate-induced myoclonus during anesthesia induction..The target plasma remifentanil concentration of 6 ng/ml can effectively reduce myoclonus after etomidate injection and attenuate the intubation response.更多还原