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目的比较小剂量瑞芬太尼和芬太尼对小儿经口气管插管血液动力学反应的影响。方法择期在全身麻醉下行整形外科手术患儿90例,ASAⅠ或Ⅱ级,年龄3-9岁,随机分为3组(n= 30):对照组(C组)、芬太尼组(F组)和瑞芬太尼组(R组)。气管插管前5 min行麻醉诱导,C组和F组分别静脉注射生理盐水0．2 ml／kg或芬太尼2μg／kg,插管前2 min三组均静脉注射维库溴铵0．1 mg／kg和异丙酚2．5 mg／kg,插管前1．5 min R组在30 s内静脉输注瑞芬太尼1μg／kg。采用直接喉镜行经口气管插管。记录麻醉诱导前(基础值)、诱导后即刻、气管插管时和插管后1、2、3、4、5 min时的血压和心率(HR),计算各对应时点HR和收缩压(SBP)的乘积(RPP)。记录插管时间、从插管操作开始至出现SBP和HR最大值的时间(TMAX-SBP和TMAX-HR)以及从插管操作完成至SBP和HR恢复至诱导后即刻值的时间(TR-SBP和TR-HR)。结果与基础值相比,诱导后即刻各组血压均降低,F组和R组降低较C组明显(P<0．05),C组HR增快(P<0．05),F组和R组HR保持稳定;气管插管致各组血压、HR和RPP升高(P<0．05),以C组最为明显,R组最轻;R组TMAX-SBP和TMAX-HR长于C组和F组,TR-SBP和TR-HR短于C组和F组(P<0．05)。结论与小剂量芬太尼相比,小剂量瑞芬太尼可更有效地抑制小儿经口气管插管的血液动力学反应。
Objective To compare the effects of small doses of remifentanil and fentanyl on hemodynamic responses to orotracheal intubation in children. Methods Totally 90 children with ASA Ⅰ or Ⅱ undergoing general surgery under general anesthesia were randomly divided into 3 groups (n = 30): control group (C), fentanyl group (F group) ) And remifentanil group (R group). Anesthesia was induced 5 min before endotracheal intubation, intravenous injection of vecuronium 0.2 mg / kg or fentanyl 2 μg / kg in group C and group F, and intravenous vecuronium 0 in group 3 min before intubation. 1 mg / kg and propofol 2.5 mg / kg, 1.5 min before intubation. R group received intravenous remifentanil 1 μg / kg within 30 seconds. Direct laryngoscope through the mouth intubation. The blood pressure and heart rate (HR) before anesthesia induction (basal value), immediately after induction, endotracheal intubation and at 1, 2, 3, 4, 5 min after intubation were recorded. HR and systolic blood pressure SBP) (RPP). The time for intubation, the time from intubation to the onset of SBP and HR maxima (TMAX-SBP and TMAX-HR), and the time from completion of intubation until SBP and HR were restored to their immediate post-induction values (TR-SBP And TR-HR). Results Compared with the basal value, the blood pressure in each group was decreased immediately after induction, but decreased significantly in group F and group R compared with group C (P <0.05), and in group C (P <0.05) The HR of HR and RPP in each group increased significantly (P <0.05), the most obvious in group C and the lightest in group R; the TMAX-SBP and TMAX-HR in group R were longer than those in group C And group F, TR-SBP and TR-HR were shorter than those in group C and group F (P <0.05). Conclusions Compared with low-dose fentanyl, low-dose remifentanil can more effectively inhibit the hemodynamic response of orotracheal intubation in children.