CAJ | 학술논문

目的：比较芬太尼、瑞芬太尼和舒芬太尼对依托咪酯麻醉诱导气管插管时血液动力学和肌阵挛的影响。方法 ASAⅠ或Ⅱ级患者120例,年龄≥65岁,随机分为4组,每组30例。 C组：接受生理盐水10 mL, F组、R组和S组分别静脉给予芬太尼2μg/kg、瑞芬太尼2μg/kg和舒芬太尼0．2μg/kg预处理,其中R组依托咪酯0．2~0．3 mg/kg诱导前1 min,持续静脉输注瑞芬太尼0．1μg/( kg·min)。静注顺阿曲库铵0．15~0．2 mg/kg后行气管插管。记录有关时段的收缩压( SBP)、平均动脉压( MAP)、心率( HR)、肌阵挛强度和发生率。结果 R组在插管后血液动力学变化比C组、F组和S组显著减少。 R组SBP、HR≥基础值的30%、SBP≥180 mmHg和HR≥120次/min的发生率(0、10%、0、0)低于C组(83%、87%、37%、30%)和F组(60%、70%、27%、13%)。 F组、R组和S组肌阵挛强度和发生率显著低于C组。结论瑞芬太尼预处理抑制依托咪酯诱导气管插管时心血管反应的效果优于芬太尼和舒芬太尼。三种阿片制剂均明显减少肌阵挛发生率和肌颤强度。
목적：비교분태니、서분태니화서분태니대의탁미지마취유도기관삽관시혈액동역학화기진련적영향。방법 ASAⅠ혹Ⅱ급환자120례,년령≥65세,수궤분위4조,매조30례。 C조：접수생리염수10 mL, F조、R조화S조분별정맥급여분태니2μg/kg、서분태니2μg/kg화서분태니0．2μg/kg예처리,기중R조의탁미지0．2~0．3 mg/kg유도전1 min,지속정맥수주서분태니0．1μg/( kg·min)。정주순아곡고안0．15~0．2 mg/kg후행기관삽관。기록유관시단적수축압( SBP)、평균동맥압( MAP)、심솔( HR)、기진련강도화발생솔。결과 R조재삽관후혈액동역학변화비C조、F조화S조현저감소。 R조SBP、HR≥기출치적30%、SBP≥180 mmHg화HR≥120차/min적발생솔(0、10%、0、0)저우C조(83%、87%、37%、30%)화F조(60%、70%、27%、13%)。 F조、R조화S조기진련강도화발생솔현저저우C조。결론서분태니예처리억제의탁미지유도기관삽관시심혈관반응적효과우우분태니화서분태니。삼충아편제제균명현감소기진련발생솔화기전강도。
Objective To compare the effects of fentanyl,remifentanil and sufentanil on the hemodynamic re-sponse to intubation and myoclonus during etomidate induction in elderly patients. Methods 120 cases ( ASAⅠorⅡ) aged over 65 were randomly assigned to 4 groups. Group C (n=30) received normal saline 10 mL,group F (n=30), group S (n=30) and group R (n=30) were pretreated with fentanyl 2 μg/kg or sufentanil 0. 2 μg/kg or remifentanil 2 μg/kg with continuous infusion of 0. 1 μg/( kg·min) at 1 min before induction with etomidate 0. 2 ~0. 3 mg/kg. Endotracheal intubation was performed after administration of cisatracurium 0. 15~0. 2 mg/kg. Systolic blood pressure ( SBP) ,mean arterial pressure( MAP) ,heart rate ( HR) ,and the incidence and intensity of myoclonus were recorded. Results After intubation,group R showed significant decrease compared with group C and group F in all of the hemo-dynamic variables measured. The incidence of increase in SBP and HR more than 30%of the baseline levels,SBP≥180 mmHg,HR≥120 beats/min were significantly lower in group R (0,10%,0 and 0) compared with groups C (83%, 87%,37%and 30%) and group F (60%,70%,27%and 13%). The frequency and intensity of myoclonus were sig-nificantly decreased in three groups ( F/R/S) compared with group C. Conclusion Pretreatment with remifentanil can suppress the cardiovascular reactions to endotracheal intubation more effectively than that of fentanyl and sufentanil dur-ing etomidate induction. The incidence of myoclonus is significantly decreased in three opioids.