Cohendy R, Lefrant J Y, Laracine M, Rebiere T, Eledjam J J
Department of Anaesthesia and Intensive Care, Centre Hospitalier Régional et Universitaire de Nimes, France.
Br J Anaesth. 1992 Dec;69(6):595-8. doi: 10.1093/bja/69.6.595.
Fentanyl has been shown to increase the overall resistance to inspiratory flow of the ventilatory system (Rmax). Rmax is the sum of the airway resistance (Raw) and of the non-Newtonian resistance (delta R) which may result from the viscoelastic properties of the thoracic tissues, from inequalities of the regional time constants within the lung, or from both. A bronchoconstrictor challenge may increase the magnitude of variation in regional time constants. Thus, in order to describe the effect of fentanyl on the two components of Rmax, this study was performed, with the end-inflation occlusion method, during paralysis and mechanical ventilation in 10 normal men undergoing barbiturate anaesthesia for minor urological procedures. The patients were anaesthetized with methohexitone and paralysed with vecuronium. Before administration of fentanyl, delta R accounted for 56% of Rmax. Fentanyl 5 micrograms kg-1 elicited a significant increase in Rmax (+34.5%; P = 0.005) and a parallel increase in both Raw (+35.2%, P = 0.017) and delta R (+33.5%, P = 0.005). The increase in Raw, but not in delta R, was reversed by atropine, suggesting that the increase in these two components of Rmax was not linked. Thus fentanyl increased both components of Rmax, but the effects of fentanyl on Raw and delta R seemed to depend on different mechanisms.
芬太尼已被证明会增加通气系统吸气气流的总阻力（Rmax）。Rmax是气道阻力（Raw）与非牛顿阻力（δR）之和，非牛顿阻力可能源于胸壁组织的粘弹性特性、肺内区域时间常数的不均一性，或两者兼而有之。支气管收缩激发试验可能会增加区域时间常数的变化幅度。因此，为了描述芬太尼对Rmax两个组成部分的影响，本研究采用终末充气阻断法，在10名接受巴比妥类麻醉进行小型泌尿外科手术的正常男性患者处于麻痹状态并进行机械通气期间进行。患者用美索比妥麻醉，用维库溴铵使其麻痹。在给予芬太尼之前，δR占Rmax的56%。5微克/千克的芬太尼引起Rmax显著增加（+34.5%；P = 0.005），同时Raw（+35.2%，P = 0.017）和δR（+33.5%，P = 0.005）也平行增加。Raw的增加而非δR的增加可被阿托品逆转，这表明Rmax这两个组成部分的增加并无关联。因此，芬太尼增加了Rmax的两个组成部分，但芬太尼对Raw和δR的影响似乎取决于不同的机制。
