【摘要】 目的研究单次静注等效剂量瑞芬太尼与芬太尼复合异丙酚麻醉诱导后喉镜置入和气管插管的插管条件、血流动力学的变化。方法40例ASAⅠ～Ⅱ级择期手术病人,随机分为两组,每组各20例。在静注异丙酚2mg/kg,维库溴胺0.12mg/kg后,R组给予瑞芬太尼2μg/kg,F组给予芬太尼2.4μg/kg,3min后行气管内插管。观察气管插管期血流动力学变化与插管条件等情况。插管条件采用4分评分系统评价5个变量指标,即下颌松弛度、喉镜放置的难易、声带的位置、咳嗽反射、肢体运动情况。结果两组插管成功率均为100%。插管条件满意率R组85%(17/20),F组80%(16/20);两组满意率差异无统计学意义(P>0.05)。与基础值比较,两组在插管前即刻及R组在插管后5min时MAP明显降低(P<0.05或P<0.01);与F组比较,R组在插管后1min时MAP明显降低,在插管后3min时MAP明显升高(P<0.05或P<0.01)。与基础值比较,两组在插管前即刻及R组在插管后3min、插管后5min时HR明显均减慢(P<0.05);R组在插管后1min、3min、5min时HR明显低于F组(P<0.05或P<0.01)。两组麻醉诱导后低血压、心动过缓发生率差异无统计学意义(P>0.05)。结论等效剂量的瑞芬太尼与芬太尼复合异丙酚麻醉诱导取得了一样良好的插管条件,在抑制插管引起的心血管反应方面瑞芬太尼优于小剂量芬太尼。更多还原

【Abstract】 Objective To study effect of the isoeffect-dose of remifentanil and fentanyl combined with propofol on the tracheal intubating conditions and haemodynamic changes to laryngoscopy and tracheal intubation during induction of anaesthesia. Methods Forty ASA physical status I~II patients were administered propofol 2mg/kg and vecuronium 0.12mg·kg-1·h-1 and remifentanil 2μg/kg (group R) or fentanyl 2.4μg/kg (group F) as a rapid bolus. Intubation condition and haemodynamic changes in intra-tracheal intubation were observed. Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, jaw relaxation, position of vocal cords, degree of coughing and limb movement.Results Tracheal intubation was successful in all patients. Excellent or good intubation conditions was no significant difference between in group R and in group F (85% and 80%, respectively; P>0. 05). MAP in two groups at pre-intubatton and in group R at 5 min post-intubatton were decreased significantly than baseline (P<0.05 or P<0.01). MAP at 1 min post-intubatton was decreased significantly and at 3 min post-intubatton was increased significantly in group R than in group F(P<0.05 or P<0.01). HR in two groups at pre-intubatton and in group R at 3, 5 min post-intubatton were decreased significantly than baseline (P<0.05). HR at 1, 3, 5 min post-intubatton was significantly lower in group R than in group F (P<0.05 or P<0.01). The incidence of hypotension and bradycardia in two groups there was no significant difference (P>0. 05). Conclusion The isoeffect-dose of remifentanil and fentanyl combined with propofol provides acceptable tracheal intubating conditions, and remifentanil could depress the cardiovascular response to laryngoscopy and tracheal intubation effectively and better than minidose fentanyl.更多还原