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目的:观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法:40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前(T0)、诱导后2min(T1)、插管后1、2min(T2、T3)记录心率、收缩压和舒张压。结果:两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低(P<0.05或P<0.01),心率均减慢(P<0.05或P<0.01);瑞芬太尼组T2、T3时收缩压、舒张压降低(P<0.05或P<0.01),心率减慢(P<0.05);芬太尼组T2、T3时收缩压、舒张压升高(P<0.05),心率增快(P<0.05)。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低(P<0.05),心率减慢(P<0.05)。结论:瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。
Objective: To observe the effects of equivalent doses of remifentanil and fentanyl-induced tracheal intubation on hemodynamics in children. Methods: Forty children undergoing elective general anesthesia were randomly divided into remifentanil group and fentanyl group. The anesthesia was induced by midazolam 0.15mg / kg, propofol 2.5mg / kg, fentanyl 2.5μg / kg or Remifentanil 2 μg / kg and vecuronium 0.1 mg / kg. Heart rate, systolic pressure, and diastolic blood pressure were recorded before anesthesia induction (T0), 2 minutes after induction (T1), and 1,2 minutes after intubation (T2, T3). Results: The indexes of hemodynamics before induction in both groups were similar. Compared with T0, systolic blood pressure and diastolic blood pressure were decreased in both groups (P <0.05 or P <0.01), heart rate was decreased (P <0.05 or P <0.01) Systolic blood pressure and diastolic blood pressure were decreased (P <0.05 or P <0.01), heart rate was decreased (P <0.05); systolic blood pressure and diastolic blood pressure were increased in the fentanyl group at T2 and T3 (P <0.05) (P <0.05). Compared with the fentanyl group, the systolic blood pressure and diastolic blood pressure were lower in the remifentanil group (P <0.05) and the heart rate was slower at T1, T2 and T3 (P <0.05). CONCLUSIONS: Remifentanil is more effective than fentanyl in reducing the cardiovascular response to tracheal intubation in general anesthesia.