瑞芬太尼对有无气管插管刺激时的中潜伏期听觉诱发电位及血流动力学测量的影响。

The effect of remifentanil on the middle latency auditory evoked response and haemodynamic measurements with and without the stimulus of orotracheal intubation.

作者信息

Wright D R, Thornton C, Hasan K, Vaughan D J A, Doré C J, Brunner M D

机构信息

Imperial College, Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Northwick Park Hospital, Harrow, Middlesex, UK.

出版信息

Eur J Anaesthesiol. 2004 Jul;21(7):509-16. doi: 10.1017/s0265021504007021.

DOI:10.1017/s0265021504007021

PMID:15318461

Abstract

BACKGROUND AND OBJECTIVE

Changes in the middle latency auditory evoked response following the administration of opioids have been shown. However, it remains unclear as to whether these changes are due to a direct depressant effect of opioids on the middle latency auditory evoked response itself, or an indirect effect on account of their action in attenuating central nervous system arousal associated with noxious stimuli. By comparing changes in the middle latency auditory evoked response in intubated and non-intubated patients, receiving saline or remifentanil in different doses, this study attempts to answer this question.

METHODS

Fifty-four patients were anaesthetized with isoflurane and nitrous oxide (0.9 MAC) and randomized to 1-6 groups. Groups 1-3 received a bolus injection of either saline 0.9%, low-dose remifentanil (1 microg kg(-1)) or high-dose remifentanil (3 microg kg(-1)) prior to intubation of the trachea. Groups 4-6 were not intubated following the bolus injection.

RESULTS

Pa and Nb amplitudes of the middle latency auditory evoked response increased by 82% and 79% with intubation in the saline group (P < 0.005) and these changes were not seen in the patients given remifentanil. There was a significant linear trend for the reduction in Pa and Nb amplitude with increasing remifentanil dose (P < 0.05). In the absence of endotracheal intubation remifentanil had no effect on either the amplitudes or latencies of the waves Pa and Nb and there was no effect of dose. For the haemodynamic measurements remifentanil attenuated the pressor response to intubation (P < 0.001) and had a significant dose-related effect (P < 0.001) in the absence of intubation.

CONCLUSIONS

We demonstrated an effect of remifentanil on both the middle latency auditory evoked response and haemodynamic changes to endotracheal intubation. For the non-intubated patients there was only an effect of remifentanil on the haemodynamic measurements. This suggests that remifentanil has an effect on the middle latency auditory evoked response in attenuating the arousal associated with intubation of the trachea but has no effect in the absence of a stimulus.

摘要

背景与目的

已有研究表明，给予阿片类药物后，中潜伏期听觉诱发电位会发生变化。然而，这些变化是由于阿片类药物对中潜伏期听觉诱发电位本身具有直接抑制作用，还是因其减弱与有害刺激相关的中枢神经系统觉醒的作用而产生的间接效应，目前尚不清楚。本研究通过比较接受不同剂量生理盐水或瑞芬太尼的插管患者和非插管患者中潜伏期听觉诱发电位的变化，试图回答这个问题。

方法

54例患者接受异氟烷和氧化亚氮（0.9MAC）麻醉，并随机分为1 - 6组。第1 - 3组在气管插管前分别给予0.9%生理盐水、低剂量瑞芬太尼（1μg·kg⁻¹）或高剂量瑞芬太尼（3μg·kg⁻¹）静脉推注。第4 - 6组在静脉推注后不进行气管插管。

结果

生理盐水组插管后中潜伏期听觉诱发电位的Pa波和Nb波振幅分别增加了82%和79%（P < 0.005），而给予瑞芬太尼的患者未出现这些变化。随着瑞芬太尼剂量增加，Pa波和Nb波振幅降低呈现显著的线性趋势（P < 0.05）。在没有气管插管的情况下，瑞芬太尼对Pa波和Nb波的振幅及潜伏期均无影响，且剂量也无影响。对于血流动力学测量，瑞芬太尼减弱了插管引起的升压反应（P < 0.001），在没有插管的情况下具有显著的剂量相关效应（P < 0.001）。