本文選題：瑞芬太尼 + 七氟烷��； 參考：《河北北方學(xué)院》2012年碩士論文

【摘要】：七氟烷是一種新型吸入麻醉劑,具有誘導(dǎo)迅速、蘇醒快、無刺激性氣味、對呼吸和心血管系統(tǒng)影響較小、體內(nèi)代謝率低及排除迅速等優(yōu)點,近年來有逐步取代異氟烷而成為臨床上廣泛應(yīng)用的吸入麻醉藥的趨勢,無肌松條件下高濃度吸入七氟烷誘導(dǎo)氣管插管已成為小兒日間手術(shù)的主要麻醉方法之一。瑞芬太尼是一種新型的μ受體激動劑,其起效迅速、持續(xù)時間短、清除快速、代謝不依賴肝腎功能、重復(fù)或長期應(yīng)用無明顯蓄積作用,是具有良好可控性的阿片類鎮(zhèn)痛藥,被麻醉學(xué)譽為21世紀的阿片類藥。 QT間期是指心電圖上從QRS波起始至T波結(jié)束的一段時間,代表心室肌除極和復(fù)極的全過程,圍麻醉期患者如存在影響QT間期的危險因素,可大大增加誘發(fā)尖端扭轉(zhuǎn)型室性心動過速(torsade de pointes, TdP)的可能性,手術(shù)麻醉的風(fēng)險隨之加大,已引起了學(xué)術(shù)界廣泛的關(guān)注和重視。瑞芬太尼對小兒七氟烷誘導(dǎo)麻醉插管期QT間期有無影響尚未見報道。 本臨床研究觀察靜注瑞芬太尼對小兒七氟烷吸入誘導(dǎo)麻醉插管期QT間期和血流動力學(xué)參數(shù)的影響,比較不同劑量瑞芬太尼對QT間期及血流動力學(xué)的影響,旨在探索應(yīng)用瑞芬太尼的最佳劑量,為小兒尋求一種安全的麻醉方法提供理論依據(jù)。 研究對象選擇擬在氣管插管全麻下行手術(shù)的男性患兒60例,ASAⅠ級,年齡(3-6)歲,體重(14-25)kg,隨機分為3組：S組(插管前2mins給予生理鹽水)、R0.5組(插管前2mins給予瑞芬太尼0.5μg·kg-1)和R1.0組(插管前2mins給予瑞芬太尼1.0μg·kg-1)。麻醉誘導(dǎo)：所有患兒均不給術(shù)前藥。麻醉誘導(dǎo)前排空貯氣囊,七氟烷揮發(fā)罐刻度調(diào)至8%,預(yù)充麻醉回路60s后行麻醉誘導(dǎo),麻醉醫(yī)生指導(dǎo)患兒深呼吸,在一次最大呼氣后,將面罩緊扣患兒面部,囑其繼續(xù)深呼吸,患兒入睡后七氟烷吸入濃度減為3%～4%,氧流量4L·min-1,必要時給予輔助呼吸,建立液路。于誘導(dǎo)5mins時三組分別于30s內(nèi)給予生理鹽水1mL (Group S)、瑞芬太尼0.5μg·kg-1mL (Group R0.5)、瑞芬太尼1.0μg·kg-11mL (Group R1.0), lmin后行氣管插管,插管后連接麻醉機行機械通氣,七氟烷吸入濃度減至2%,氧流量2L·min-1,潮氣量(8～10)mL·kg-1,吸呼比1:2,呼吸頻率16beat·min-1。觀察并記錄患兒圍麻醉插管過程中各時間點(誘導(dǎo)Omin(T1),誘導(dǎo)1min時(T2),誘導(dǎo)3mins時(T3),誘導(dǎo)5mins時(T4),給予等量瑞芬太尼或生理鹽水后1min即誘導(dǎo)6.5min時(T5),插管前即刻即誘導(dǎo)7min時(T6)和插管后1min即8.5min時(T7))的QT間期和校正QT間期(corrected QT interval, QTc)及平均動脈壓(mean arterial pressure, MAP)和心率(heart rate, HR)的變化。QT間期�、�?qū)?lián)連續(xù)6次心電圖記錄的QT間期和QTc的平均值。 研究結(jié)果顯示：QTc的變化：(1)給予生理鹽水或瑞芬太尼(T5)之前：與誘導(dǎo)0min(T1基礎(chǔ)值相比,三組在誘導(dǎo)lmin (T2)時均無明顯變化,誘導(dǎo)3mins (T3)和5mins (T4)時三組的QT間期與T1相比均明顯延長(P0.01),三組間T3和T4時段的QT間期比較無統(tǒng)計學(xué)意義(P0.05)：(2)給予生理鹽水或瑞芬太尼(T5)之后：Group S給予生理鹽水后1min(T5)QT間期與同組T3,T4無明顯差異,Group R0.5給予瑞芬太尼0.5μg·kg-1后1min (T5) QT間期相對于同組T3,T4明顯縮短(P0.05),與基礎(chǔ)值相比仍延長(P0.05), GroupR1.0給予瑞芬太尼1.0μg·kg-1后1min(T5) QT間期比同組T3,T4明顯縮短(P0.01),與基礎(chǔ)值相比無明顯差異,Group R1.0T5的QT間期比Group R0.5T5的QT間期縮短(P0.05),插管前即刻(T6)時三組的QT間期與各自組內(nèi)T5時的QT間期無明顯差異,組間差異同T5時段,插管后1min時Group S QT間期比同組T3-T6時段明顯延長(P0.05),Group R0.5和Group R1.0T7的QT間期與本組T5,T6無明顯差異,Group R0.5和Group R1.0組間比較有差異(P0.05),兩組比Group S均明顯縮短(P0.01)。HR和MAP的變化：三組HR和MAP在T2-T4時段比基礎(chǔ)值略下降,組間、組內(nèi)差異均無統(tǒng)計學(xué)意義(P0.05)。S組T5,T6時HR和MAP與基礎(chǔ)值無明顯差異,插管后1min(T7)均明顯增加(P0.05)。Group R0.5和Group R1.0T5～T7時段HR和MAP與基礎(chǔ)值相比明顯下降(P0.05),與自身插管前后相比HR和MAP較平穩(wěn),組間比較無明顯差異。 經(jīng)分析研究結(jié)果得出以下結(jié)論：(1)高濃度七氟烷吸入麻醉誘導(dǎo)3mins和5mins時QTc明顯延長,但均未見致命性心律失常的發(fā)生：(2)插管前給予瑞芬太尼靜注可有效抑制小兒七氟烷吸入麻醉誘導(dǎo)插管期QTc間期和MAP,HR的改變；(3)瑞芬太尼1.0μg·kg-1靜注減輕QTc間期改變的作用更完善,優(yōu)于瑞芬太尼0.5μg·kg-1靜注。
[Abstract]:Seven fluorothane is a new type of inhalation anesthetic, which has the advantages of rapid induction, quick awakening, no irritation smell, less influence on the respiratory and cardiovascular system, low metabolic rate in the body and rapid elimination. In recent years, it has gradually replaced isoflurane and became a trend of inhalation anesthetics widely used in clinical practice, with high concentration of seven inhalation without muscle relaxation. Halothane induced tracheal intubation has become one of the main anesthetic methods in children's daytime surgery. Remifentanil is a new type of muon receptor agonist. It has rapid effect, short duration, rapid clearance, metabolism without liver and kidney function, repeated or long-term application without obvious accumulative effect. It is an opioid analgesic with good controllability and is anesthetized. It is known as the opioid in twenty-first Century.
QT interval refers to a period of time from the beginning of the QRS wave to the end of the T wave on the electrocardiogram, representing the whole process of depolarization and repolarization of the ventricular muscle. The peri anaesthesia patients, such as the risk factors affecting the QT interval, can greatly increase the possibility of inducing torsional ventricular tachycardia (torsade de pointes, TdP), and the risk of surgical anesthesia increases. It has attracted wide attention and attention from academia. It has not been reported whether remifentanil has any effect on the QT interval in children undergoing seven flurane induction anesthesia.
The effect of remifentanil on QT interval and hemodynamic parameters during the intubation of seven halothane anesthesia in children was observed. The effects of remifentanil on QT interval and hemodynamics were compared to explore the optimal dosage of remifentanil to provide a theoretical basis for children to seek a safe anesthetic method. According to it.
Subjects were selected 60 male children, ASA I, age (3-6) years and weight (14-25) kg, randomly divided into 3 groups: group S (before intubation 2mins was given saline), group R0.5 (before intubation 2mins gave remifentanil 0.5 g kg-1) and R1.0 group (before intubation of remifentanil 1 mu g kg-1). Anesthesia induction: All the children were not given preoperatively. The air bag was emptied before anesthesia induction, the scale of seven Fluoroalkane volatilization tank was adjusted to 8%, the anesthetic circuit was induced after 60s, and the anesthesiologist instructed the children to take deep breathing. After a maximum exhalation, the mask was kept close to the child's face and continued to breathe deeply, and the concentration of seven Fluoroalkane inhalation decreased to 3% to 4% after falling asleep. Oxygen was reduced to 3% to 4%. The flow of 4L / min-1 was given when necessary. The three groups were given 1mL (Group S) in 30s, remifentanil 0.5 mu g. Kg-1mL (Group R0.5), remifentanil 1 mu g. 2%, oxygen flow 2L / min-1, tidal volume (8~10) mL / kg-1, absorption ratio 1:2, respiratory frequency 16beat min-1., observed and recorded every time point during the perioperative anesthesia intubation of children (Omin (T1), 1min (T2) induction, inducement of 3mins, induction and induction. The interval of QT interval and the correction of the QT interval (corrected QT interval, QTc) and the changes of the mean arterial pressure (corrected QT interval, QTc) and the heart rate (T7) after the induction of 7min (T6) and after the intubation of 1min, that is, 8.5min (T7), and the changes in the mean arterial pressure (mean) and heart rate are taken as the intervals of the interval and the average of the 6 consecutive electrocardiogram records of the second lead.
The results of the study showed that: (1) prior to the induction of saline or Reventa Ni (T5), there was no significant change in the induction of lmin (T2) with the induced 0min (T1 base), and the QT interval between the three groups of 3mins (T3) and 5mins (T4) was prolonged when compared with the induced 0min (T1). The intervals between the three groups were not statistically significant. Meaning (P0.05): (2) after giving physiological saline or Reventa Ni (T5): after Group S was given physiological saline, 1min (T5) QT interval was not significantly different from that of the same group of T3 and T4, Group R0.5 gave Reventa Ni the interval relative to the same group. The 1min (T5) QT interval of 1min (T5) QT is shorter than that of the same group T3 and T4 (P0.01). The QT interval of Group R1.0T5 is shorter than that of the base value, and the Group R1.0T5 QT interval is shorter than that of the Group. There is no obvious difference between the intervals of the three groups and the intervals in the respective groups. The P S QT interval was significantly longer than that of the same group (P0.05), and the QT interval of Group R0.5 and Group R1.0T7 was not significantly different from that of this group. The two groups were significantly shorter than those of the T3-T6 group. There was no significant difference (P0.05) in group.S (P0.05), and there was no significant difference between HR and MAP at T6, and 1min (T7) significantly increased (P0.05) after intubation (P0.05).Group R0.5.
The results of the analysis were as follows: (1) QTc was prolonged significantly when high concentration of seven halothane induced 3mins and 5mins, but no fatal arrhythmia was found: (2) Reventa Ni intravenous infusion before intubation could effectively inhibit the QTc interval of QTc and the changes of MAP and HR in the induction of tracheal intubation in children; (3) Reventa Ni 1 The effect of intravenous injection of g kg-1 on QTc interval is more perfect than that of remifentanil 0.5 g kg-1.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R726.1

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