中国冶金工业医学杂志

瑞芬太尼与丙泊酚诱导后补注对围插管期血流动力学的影响

分类号：中图分类号：R 614文献标志码：A文章编号：1005-5495(

出版年,卷(期):页码：2013,30(1):7-8

摘要：

摘要：目的观察瑞芬太尼与丙泊酚诱导后补注对插管期心血管的稳定作用。方法拟行气管插管全麻病人227例，ASA分级I~II，麻醉诱导后SBP下降＜30%者187例，随机分为A、B、C三组，A组63例，B、C二各组62例。用瑞芬太尼1 μg/kg、丙泊酚15 mg/kg、维库溴铵01 mg/kg静脉注射诱导，2 min后A组直接气管插管，B组、C组分别补注瑞芬太尼02 μg/kg和丙泊酚诱导剂量的1/5，随后行气管插管，观察三组气管插管完成时即刻（T1）、3 min（T2）、5 min（T3），测量HR、SBP、DBP，并计算RPP；比较三组插管后四项指标的变化并与基础值（T0）比较。结果与T0时相比，A组插管后T1、T2时的HR 、SBP、RPP均明显增加（P＜005），而B、C二组插管后T1、T2时HR、SBP、RPP与T0时比较差异无统计学意义（P＞005）；与A组比较，B、C二组插管后T1时的HR 、SBP、RPP均明显下降（P＜005），而B组T1时的DBP与A组比较差异无统计学意义（P＞005）；B、C二组间各时点HR 、SBP、RPP比较差异无统计学意义（P＞005）；T3时A、B、C三组的HR 、SBP、DBP、 RPP及与T0时比较差异无统计学意义（P＞005）。结论诱导后补注适量的瑞芬太尼或丙泊酚均可有效减轻气管插管时的心血管反应，对有高血压/缺血性心脏病的患者，丙泊酚较瑞芬太尼更利于心肌灌注。

Abstract:Objective Observate the cardiovascular stability of Propofol or remifentanil for intubation after supplementary of inductionMethods 227 ASA Ⅰ～Ⅱ patients undergoing tracheal intubation general anesthesia,187 cases of SBP＜30% declined after induction of anesthesia,were randomly divided into three groups,63 cases in group A,62 cases in group B/CAnesthesia was induced With remifentanil 1 μg/kg,propofol 1.5mg/kg,and Vecuronium 0.1mg/kg,tracheal intubation in group A after 2min,group B and Group C respectively supplement with remifentanil 0.2μg/kg and one\|fifth induced dose of propofol,then HR,and SBP,and DBP were monitored,and calculate RPP at tracheal intubation completed immediate (T1),and 3min (T2),and 5min (T3) after intubation in three group,compare the difference of four value after intubation and compare with the Basic value (T0)Results As compared with T0，HR,SBP,RPP at T1,T2 after intubation in group A were increased significantly(P＜0.05),compared with T0，the difference of HR,SBP,RPP at T1,T2 after intubation in group B and C were similar(P＞0.05);compared with group A,HR,SBP,RPP at T1,T2 after intubation in group B and C were decreased significantly(P＜0.05),compared with group A，the difference of DBP at T1in group B was similar(P＞0.05);HR,SBP,RPP at each time point in group B and C were no significant difference (P＞0.05);compared with T0,HR,SBP,DBP,RPP at T3 in group A,B,C were no significant difference(P＞0.05)Conclusion Supplementary suitable dose of remifentanil or propofol after induction would be reduce the cardiovascular response to tracheal intubation effectively,compared with remifentanil,propofol was more conducive to heart perfusion in hypertension or ischemic heart disease patients.

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参考文献：

［1］耿智隆，刘东，汪惠文，等氯普鲁卡因对经鼻气管插管心血管应激反应的影响\[J\]临床麻醉学杂志，2008，24：406\|408

［2］庄心良，曾因明，陈伯銮主编现代麻醉学\[M\]北京：人民卫生出版社，2006：481\|487

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