芬太尼复合诱导气管插管对神经外科病人大脑中动脉血流速率的影响

摘要

Objective: To evaluate the effect of fentanyl-etomidate coinduction on cerebral blood flow velocity in neurosurgical patients. Methods: 20 patients were allocated randomly into two groups ( 10 each): F5 group, fentanyl 5μg/kg； F10 group, Fentanyl 10μg/kg. Anesthesia was induced with diazepam 0. 1mg/kg, fentanyl 5μg/kg(F5 group)or 10μg/kg(F10 group), vecuromum 0. 1mg/kg and etomidate 0.3mg/kg. After endotracheal intubation, the ventilation was performed to maintain PETCO2 of 35-45mmHg. The middle cerebral artery blood flow velocity(V-MCA), mean artery blood pressure (MAP), heart rate(HR), PETCO2 and SpO2 were measured before induction, after intubation and at 3min after intubation.?Results: There were no significnt differences in preinduction data(weight, sex, MAP, HR) between two groups. The V-MCA decreased signifieantly (P ＜0.05) after induction and at 3min after intubation in both groups. Conclusion: Co-induction of fentanyl with etomidate could decrease cerebral artery blood flow velocity during intubation.%目的：应用经颅多普勒(TCD)研究不同剂量芬太尼和依托咪酯复合诱导气管插管对神经外科病人脑血流动力学的影响。方法：20例病人随机分成两组(每组10例)：F5组，芬太尼5μg／kg；F10组，芬太尼10μg／kg。余诱导用药相同：安定0．1mg／kg、依托咪酯0．3mg／kg、维库溴铵0．1mg／kg。采用TCD监测双侧大脑中动脉血流速率(V-MCA)，同时监测BP、HR、记录麻醉诱导前、插管前和插管后3分钟的变化。结果：与麻醉前比，插管前和插管后3分钟,两组V-MCA均明显降低(P＜0．01)；血压在插管前降低(P＜0．01),插管后恢复麻醉前水平。但两组间的变化差异无显著意义。结论：芬太尼和依托咪酯复合诱导能抑制插管刺激引起的脑血流量增加和心血管反应,减少脑血流量。