【摘要】 目的比较小剂量芬太尼、瑞芬太尼和舒芬太尼对患儿直接喉镜经口气管插管心血管反应的影响。方法选择120例施择期整形外科手术的患儿。随机平均分成对照组、芬太尼组、瑞芬太尼和舒芬太尼组,气管插管前采用盲法分别应用9g/L盐水0.2mL/kg、芬太尼2μg/kg、瑞芬太尼组1μg/kg和舒芬太尼0.2μg/kg。静脉麻醉诱导后采用直接喉镜实施经口气管插管。监测麻醉诱导前、后,气管插管时和气管插管后5min内血压(BP)和心率(HR)及观察期收缩压(SBP)和HR的变化率,并记录观察期SBP和HR达最大值时间及其气管插管后恢复至麻醉诱导后值时间。结果BP和HR基础值及气管插管时间在4组间均无显著性差异。气管插管致BP和HR较基础值显著升高,且是以对照组最为明显,芬太尼组次之,瑞芬太尼和舒芬太尼组最轻。对照组气管插管时BP和HR及其观察期最大值均显著高于芬太尼组、瑞芬太尼和舒芬太尼组;瑞芬太尼组和舒芬太尼组气管插管时的血压和HR及其观察期最大值均显著低于芬太尼组(Pa<0.05)。瑞芬太尼组观察期出现SBP和HR最大值时间显著长于对照组、芬太尼组和舒芬太尼组(Pa<0.05);舒芬太尼和瑞芬太尼组气管插管后SBP和HR恢复至麻醉诱导后值时间显著短于对照和芬太尼组(P<0.05)。瑞芬太尼和舒芬太尼组观察期SBP和HR增加大于基础值30%发生率较芬太尼组显著降低。结论与小剂量芬太尼比较,小剂量舒芬太尼和瑞芬太尼能更有效预防患儿经口气管插管的心血管反应。更多还原

【Abstract】 Objective To compare the effects of small-dose fentanyl,remifentanil and sufentanil on cardiovascular responses to laryngoscopic orotracheal intubation in children.Methods One hundred and twenty children scheduled for elective plastic surgery under general anesthesia were randomly divided into control group,fentanyl group,remifentanil group and sufentanil group (n=30 each group).Children in control,fentanyl,remifentanil and sufentanil groups received saline 0.2 mL/kg,fentanyl 2 μg/kg,remifentanil 1 μg/kg and sufentanil 0.2 μg/kg IV,respectively,using an blind method before intubation.After intravenous anesthesia induction,orotracheal intubation was performed using the direct laryngoscope.Noninvasive blood pressure(BP) and heart rate(HR) were recorded before(baseline values)and after anesthesia induction,at intubation and every minute for 5 min after intubation.Percent changes of SBP and HR during observation were calculated.Times required for occurrence of the maximum values of SBP and HR during observation,and times required for recovery of SBP and HR to the postinduction va-lues after intubation were also recorded.Results There were no significant differences among the 4 groups in the baseline values of BP,HR and the intubation time.The orotracheal intubation caused significant increases in BP and HR compared to the baseline values,which were strongest in control group,secondary in fentanyl group and least in remifentanil and sufentanil groups.BP and HR at intubation and their maximum values during observation were significantly higher in control group than those in fentanyl,remifentanil and sufentanil groups.BP and HR at intubation and their maximum values during the observation were significantly lower in sufentanil and remifentanil groups than those in fentanyl group(Pa<0.05).Times required for the occurrence of the maximum values of SBP and HR were significantly longer in remifentanil group than in control,fentanyl and sufentanil groups(Pa<0.05);Times required for the recovery of SBP and HR to the postinduction values were significantly shorter in remifentanil and sufentanil groups than those in fentanyl and control groups(P<0.05).The incidences of SBP and HR increases more than 30% of baseline value were significantly lower in remifentanil and sufentanil groups than those in fentanyl group.Conclusion Both small-dose sufentanil and remifentanil can blunt the cardiovascular responses to orotracheal intubation more effectively in children compared with small-dose fentanyl.更多还原