心理护理对瑞芬太尼全麻插管期间听觉诱发电位和血液动力学变化的观察

摘要

Objective To explore psychological care on changes in auditory evoked potential (AEP) and hemodynamics during anesthetic induction with remifentanil. Methods 30 ASA Ⅰ-Ⅱ patients were divided into study group and conrol group. The study group received psychological care one day before surgery, a intravenous injection of remifentanil of 1μg/kg 4 min before anaesthestic induction, and then a continuous infusion of remifentanil 0.1 μg/kg/min, which was decreased to 0.05μg/kg/min during anesthetic induction; while the control group received esmolol of 300μg/kg/min, which was reduced to 200 μg/kg/min during induction. The medications were terminated 10 min after intubation. AEP, ECC, HR, SBP, and RPP were compared between the two groups and then analyzed statistically. Results AEP did not differ significantly between the two groups at different time points (P>0.05). SBP, HR, and RPP changed slightly in the study group after intubation. Conclusions Psychological care is helpful in making remifentanil more effectively suppress the adverse cardiovascular reactions during intubation.%目的 探讨心理护理对瑞芬太尼捕管期间听觉诱发电位和血液动力学变化的影响,评价心理护理对插管时AAI(听觉诱发电位指数)和血液动力学变化,判断心理护理有助于瑞芬太尼抑制气管插管时心血管的副反应,为临床寻求一种安全有效的最佳方法.方法 对30例患者ASAⅠ-Ⅱ级,分成两组,观察组(Ⅰ组)术前1天实施心理护理,麻醉诱导前4 min,静注瑞芬太尼1μg/kg后,以美国百特Baxter AS4OA型微量泵持续静注瑞芬太尼0.1μg/(kg·min),诱导时,瑞芬太尼改为0.05μg/(kg·min);对照组(Ⅱ组)以持续静注艾司洛尔300μg/(kg·min),诱导时,改为200μg/(kg·min).后静注麻醉诱导剂,待肌肉完全松驰时行气管内插管,至捕管后10分钟停药.比较两组治疗期间AAI、ECG、HR、SBP、RPP,经统计学处理.结果 两组病人各时间点的AAI值差异无显著性(P>0.05).观察组ISBP、HR、RPP在气管捕管后的全过程变化小.结论 心理护理有助于瑞芬太尼能够更有效地抑制气管捅管时心血管副反应.