我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

瑞芬太尼对中老年人心率及心率变异性的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第1期
页码:
103-106
栏目:
临床研究
出版日期:
2010-10-27

文章信息/Info

Title:
Effects of remifentanil on heart rate and heart rate variability in middle-aged and elderly patients
作者:
苏畅1; 裴焕爽2; 马兰3; 张涛3; 李力兵3
1.武警广西总队医院外二科，广西 南宁 530012；2.河北医科大学第四医院麻醉科，河北 石家庄 050011；3.解放军总医院心血管外科暨全军心脏外科研究所,北京 100853
Author(s):
SU Chang1;  PEI Huan-shuang2;  MA Lan3;  ZHANG Tao3;  LI Li-bing3
1.Department of Surgery, Hospital of Guangxi Provincial Corps, People’s Armed Police Forces, Nanning 530012, Guangxi, China; 2.Department of Anesthesiology, Fourth Affiliated Hospital, Hebei Medical University, Shijiazhuang 050011, Hebei, China; 3.Department of Cardiovascular Surgery, PLA General Hospital, Beijing 100853, China
关键词:
瑞芬太尼; 心率; 心率变异性; 年龄
Keywords:
remifentanil;  heart rate;  heart rate variability;  age
分类号:
R971.2
DOI:
-
文献标识码:
A
摘要:
目的: 观察瑞芬太尼对不同年龄组患者心率及心率变异性的影响，以及阿托品对心率的保护作用。方法： 选择行择期手术的全麻患者，先按年龄分组：中年(M，40～59岁)和老年(O,≥60岁)，每一组又随机分为单纯应用瑞芬太尼(R)组和阿托品(A)预处理，共分为4个组（每组20例）：中年单纯瑞芬太尼组（RM）、老年单纯瑞芬太尼组（RO）、中年阿托品预处理组（ARM）和老年阿托品预处理组（ARO）。RM组和RO组静脉恒速泵入瑞芬太尼2 μg/kg，泵速为1 μg/(kg·min)。其余两组患者给药方式相同，只是在静脉应用瑞芬太尼之前30 min肌肉注射阿托品0.5 mg。记录用药前（T0）、用药后1 min(T1)、2 min(T2)、3 min(T3)、5 min(T5)、7 min(T7)等各时间点的心率(HR)、低高频比值(LF/HF)。结果： RM组和RO组患者的HR、LF/HF值在T1~T7各时间点，与T0相比均降低(P<0.05)；而ARM组患者给药后的各时间点的HR、LF/HF值与T0相比较，未出现有统计学意义的变化；ARO组的HR和LF/HF值在给药后也出现有统计学意义的下降（P<0.05），但与RO组相比，下降的幅度较小。结论： 静脉泵入瑞芬太尼时，中老年患者心率及心率变异性明显降低，而阿托品可以拮抗瑞芬太尼减慢心率的作用，因此瑞芬太尼应用于中老年患者时，提倡预先应用阿托品以预防心动过缓。
Abstract:
AIM: To investigate the effects of remifentanil on the heart rate (HR) and the heart rate variability (HRV) in middle-aged and elderly patients. METHODS: Eighty patients were divided into middle-aged group (45-59 years) and elderly group (≥60 years). The two groups were further randomly divided into pre-atropine group (ARM and ARO group) and remifentanil-only group (RM and RO group). Patients in ARM and ARO group were given atropine 0.5 mg (IM) 30 min before induction. IV injection of remifentanil (2 μg/kg) was given for 2 min (1 μg/kg·min) with a target-controlled infusion pump. Heart rate (HR) and low frequency/high frequency (LF/HF) were recorded before perfused remifentanil (T0), and 1 min(T1), 2 min(T2), 3 min(T3), 5 min(T5) and 7 min(T7) after perfused remifentail. RESULTS: Within groups, compared with baseline value of RM, HR and LF/HF of RM group at the other time points were significantly decreased (P<0.05). No significant difference was found in HR and LF/HF between RM group and ARM and ARO groups. Between groups, HR and LF/HF in RM and RO groups decreased significantly (P<0.05) compared with those in T1-T7 ARM and ARO groups. CONCLUSION: HR and the HRV of middle-aged and elderly patients significantly decrease following IV injection of remifentanil (2 μg/kg for 2 min) (1 μg/kg·min). However, inhibitory effects of remifentanil on the heart can be reversed by 0.5 mg atropine (IM). It is suggested that pre-treatment of atropine can prevent bradycardia of middle-aged and elderly patients to be treated with remifentanil.

参考文献/References

[1]Elliott P, O’Hare R, Bill KM, et al. Severe cardiovascular depression with remifentanil[J]. Anesth Analg, 2000, 91(1):58-61.

[2]Joshi GP, Warner DS, Twersky RS, et al. A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study [J]. J Clin Anesth, 2002, 14(7):494-499.

[3]Hon EH, Lee ST. Electronic evaluations of the fetal heart rate. viii. patterns preceding fetal death,further observations[J]. Am J Obstet Gynecol, 1963, 87:814-826.

[4]Akselrod S, Gordon D, Ubel FA, et al. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control[J]. Science, 1981, 213(4504):220-222.

[5] Kuo TB, Lin T, Yang CC, et al. Effectofagingongender differ-ences in neural control of heart rate[J]. Am J Physiol, 1999, 277(6 Pt 2):H2233-H2239.

[6]Malliani A, Pagani M, Lombardi F, et al. Cardiovascular neural regulation explored in the frequency domain[J]. Circulation, 1991, 84(2):482-492.

[7]朴松哲,李亿军. 正常人心率变异性分析[J]. 心脏杂志, 2000, 12(5):421-422.

[8]Kanaya N, Hirata N. Differential effects of propofol and sevoflurane on heart rate variability[J]. Anesthesiology, 2003, 98(1):34-40.

[9]张文新，余微萍，徐旭仲,等. 上腹部手术不同麻醉方法对心率变异性的影响[J]. 心脏杂志, 2000, 12(5):374-376.

备注/Memo

备注/Memo:
收稿日期：2010-01-12.基金项目：国家自然科学基金（30670823）；河北省卫生厅医学科学研究重点课题计划（20090490） 通讯作者：李力兵，主任医师，主要从事心肌缺血性损伤发生机制的研究Email:llb03@tom.com 作者简介：苏畅，主治医师，硕士Email:suchang1981@yahoo.com
更新日期/Last Update: 2010-10-27