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。%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.
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