瑞芬太尼对心率影响的临床与实验研究

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (9): 1047-1052.

瑞芬太尼对心率影响的临床与实验研究

李力兵¹, 苏畅², 马兰¹, 高长青¹

¹中国人民解放军总医院心血管外科暨全军心脏外科研究所, 北京100853;
²武警广西总队医院外二科, 南宁530012, 广西

收稿日期:2009-06-04 修回日期:2009-08-06 发布日期:2020-11-03
通讯作者: 高长青, 男, 教授, 博导, 研究方向:冠脉外科的临床与基础研究。Tel:010-66938035 E-mail: heart301@heart301.net
作者简介:李力兵, 女, 教授, 硕导, 研究方向:心肌保护的基础研究。Tel:010-66938235 E-mail: llb03@tom.com
基金资助:
国家自然科学基金项目(30670823)

Effects of remifentanil on heart rate —clinical and experimental research

LI Li-bing¹, SU Chang², MA Lan¹, GAO Chang-qing¹

¹Department of Cardiovascular Surgery of PLA General Hospital, Beijing 100853, China;
²Department of Surgery, Guangxi Prorincial Corps Hospital Chinese People’s Armed Police Forces, Nanning 530012, Guangxi, China

Received:2009-06-04 Revised:2009-08-06 Published:2020-11-03

摘要/Abstract

摘要： 目的: 观察瑞芬太尼对心率(HR) 及心率变异性的影响, 并探讨其作用机制。方法: 临床部分:选择行择期手术的全麻患者40 例, 分为单纯应用瑞芬太尼组(R 组) 和阿托品预处理组(A组), 每组20 例。R 组患者静脉恒速泵入瑞芬太尼2 μg/kg, 泵速为1 μg·kg^-1 ·min^-1 ;A 组患者阿托品0.5 mg 肌肉注射30 min 后, 给予瑞芬太尼方法同R 组。记录用药前后各时间点的HR 和低高频比值(LF/HF) 。实验部分:雄性SD 大鼠24只, 随机分为3 组(n =8), 行离体心脏灌注, C 组为空白对照, R10 组和R30 组分别灌注瑞芬太尼10 ng/mL 和30 ng/mL 。记录用药前后各时间点的HR 和左室发展压(LVDP) 。结果: 组内比较:R 组患者的HR 和LF/HF 值在用药后各时间点均降低(P <0.05) ;A 组给药后的各时间点HR 和LF/HF值未出现有统计学意义的变化。组间比较:在给药后的各时间点, R 组的HR 和LF/HF 值低于A组(P <0.05) 。动物实验部分瑞芬太尼10 ng/mL和30 ng/mL 对离体鼠心的HR 和LVDP 均无影响。结论: 通过本研究发现瑞芬太尼主要是通过抑制中枢神经系统或破坏心脏自主神经系统平衡而使HR 及心率变异性明显降低, 而阿托品可以拮抗瑞芬太尼的这种HR 抑制作用。

关键词: 瑞芬太尼, 心率, 心率变异性, 离体心脏灌注, 机理

Abstract: AIM: To investigate the effects of remifentanil on heart rate (HR) and heart rate variability (HRV) in patients and isolated rat hearts, and approach its mechanism of action. METHODS: Clinical research: 40 patients were divided into two groups randomly: remifentanil-only-group(Group R, n =20) and pre-atropine-group (Group A, n =20). Group A were given atropine 0.5 mg (i. m.) 30 min before remifentanil administration. Remifentanil 2 μg/kg was administrated with TCI pump at speed of 1 μg·kg^-1·min^-1. HR and Low frequency High frequency(LF/HF) were observed and recorded before and after administration. Animal experiment: 24 SD rats were divided into three groups randomly (n =8): control group (Group C), 10 ng/mL remifentanil group (Group R10) and 30 ng/mL remifentanil group (Group R30). The isolated rat hearts were perfused with Langendorff apparatus. HR and LVDP were monitored continuously. RESULTS: HR and LF/HF in Group R were decreased significantly (P <0.05) at each observed point after remifentanil administration. But in Group A, the changes of HR and LF/HF were not observed. Compared with Group A, the HR and LF/HF at each observed point were decreased (P <0.05). Between Group R and Group A, HR and LF/HF had significant differences(P <0.05). In animal experiment there was no significant difference of HR and LVDP in the three groups. CONCLUSION: Intravenous injection of remifentanil decreases HR and HRV of patients markedly. The inhibitory effects of remifentanil on heart can be reversed by atropine. Based on animal experiment we conclude that the depression of remifentanil on heart is caused by inhibiting central nervous system or interfereing balance of autonomic nerve system.

Key words: remifentanil, heart rate, heart rate variability, isolated rat heart perfusion, mechanism

中图分类号:

R965.2

李力兵, 苏畅, 马兰, 高长青. 瑞芬太尼对心率影响的临床与实验研究[J]. 中国临床药理学与治疗学, 2009, 14(9): 1047-1052.

LI Li-bing, SU Chang, MA Lan, GAO Chang-qing. Effects of remifentanil on heart rate —clinical and experimental research[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(9): 1047-1052.

参考文献

[1] Rosow C.Remifentanil:a unique opioid analgesics[J]. Anesthesiology, 1993, 79(5): 875-876.
[2] Elloitt P, O'Hare R, Bill KM, et al.Severe cardiovascular depression with remifentanil[J]. Anesth Analg, 2000, 91(1): 58-61.
[3] 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.
[4] Akselord 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] Malliani A, PaganiM, Lombardi F, et al. Cardiovascular neural regulation explored in the frequency domain[J]. Circulation, 1991, 84(2): 482-492.
[6] Kaya D, Karaca S, Barutcu I, et al.Hear rate variability in patients with essential hyperhidrosis: dynamic influence of sympathetic and parasympathetic maneuvers[J]. Ann Noninvasive Electrocardiol, 2005, 10(1): 1-6.
[7] 邢玉英, 张加强, 贾丽, 等.食管癌切除术病人不同靶浓度瑞芬太尼复合异病酚靶控输注的麻醉效果[J]. 中华麻醉学杂志, 2005, 25(11): 865-866.
[8] 张利萍, 李民, 张弓召, 等.择期外科手术期间国人瑞芬太尼的药物动力学研究[J]. 中国药:英文版, 2006, 15(1): 33-37.
[9] Shinohara K, Aono H, Mnrμh GK, et al.Suppressive effects of remifentanil on hemodynamics in baro-denervated rabbits[J]. Can J Anaesth, 2000, 47(4): 361-366.
[10] 张旭彤, 卢园园, 黄志莲, 等.瑞芬太尼抑制纤支镜辅助经鼻气管插管反应的半数有效效应室浓度测定[J]. 中国临床药学杂志, 2009, 18(2): 82-85.
[11] 满元元, 姜雨鸽, 徐龙河, 等.全静脉麻醉和平衡麻醉对支撑喉镜声带手术应激反应影响[J]. 中国临床药理学与治疗学, 2006, 11(5): 497-500.

[1]	伍小霞, 周虎. 瑞芬太尼在重型颅脑外伤患者术后ICU镇静镇痛中的应用[J]. 中国临床药理学与治疗学, 2022, 27(10): 1119-1124.
[2]	杨璐，魏滨，张利萍，毕姗姗，卢炜. 应用响应曲面模型法研究丙泊酚与瑞芬太尼的最佳配伍剂量[J]. 中国临床药理学与治疗学, 2020, 25(4): 413-420.
[3]	廖朝霞，周礼生，陆福鼎，李玉娟. 无肌松药条件下七氟烷诱导时右美托咪定对瑞芬太尼维持最佳气管插管条件的半数有效血浆浓度的影响[J]. 中国临床药理学与治疗学, 2019, 24(8): 922-927.
[4]	余亮，周大春，刘洋，高斌. 瑞芬太尼对妇科腹腔镜气腹期间眼内压的影响[J]. 中国临床药理学与治疗学, 2017, 22(9): 1062-1066.
[5]	袁点，余果，王大新. 酪氨酸激酶抑制剂对QT间期的影响及临床意义研究进展[J]. 中国临床药理学与治疗学, 2017, 22(7): 825-830.
[6]	雍小兰，李楠，杜晓琳，王蓝天，康辉. 抗胆碱药盐酸戊乙奎醚减慢健康受试者心率的初步观察[J]. 中国临床药理学与治疗学, 2016, 21(1): 77-81.
[7]	刘若海, 韩园, 刘启星, 李影, 王怡鸾, 张旭彤, 李军. 右美托咪定复合瑞芬太尼对全麻气管拔管反应的影响[J]. 中国临床药理学与治疗学, 2015, 20(7): 788-792.
[8]	路志红, 董辉, 刘明富, 冯大鹏, 董海龙. 瑞芬太尼靶控输注对患者意识消失的丙泊酚效应室浓度的影响[J]. 中国临床药理学与治疗学, 2014, 19(8): 904-906.
[9]	曹迎亚, 鲁卫华, 姜小敢, 鲁美静, 吴敬医, 秦雪梅, 姚卫东. 血清乙酰胆碱受体抗体阳性和阴性重症肌无力患者罗库溴铵肌松时效的比较[J]. 中国临床药理学与治疗学, 2014, 19(10): 1153-1157.
[10]	刘文洁, 柯永胜, 杨浩, 蔚有权, 曹蘅. 国产奥美沙坦酯治疗轻中度原发性高血压的单中心疗效和安全性评价[J]. 中国临床药理学与治疗学, 2013, 18(9): 1053-1058.
[11]	秦统鑫, 帅训军, 卜庆丽, 艾登斌. 兰地洛尔对Ⅱ型糖尿病患者气管插管心率变异性及QT间期的影响[J]. 中国临床药理学与治疗学, 2013, 18(12): 1388-1391.
[12]	秦雪梅, 鲁卫华, 金孝岠, 姚卫东, 唐宁. 罗库溴胺用于重症肌无力患者胸腺切除术的肌松效应[J]. 中国临床药理学与治疗学, 2012, 17(11): 1263-1267.
[13]	王武, 杨莉, 吴绍芳, 吴炜, 雷李培. 右美托咪啶复合瑞芬太尼在清醒气管插管中的应用[J]. 中国临床药理学与治疗学, 2012, 17(10): 1163-1166.
[14]	郑羡河, 蒋宗明, 陈忠华, 张昌峰, 胡双燕. 氟比洛芬酯预防瑞芬太尼麻醉后痛觉过敏的临床研究[J]. 中国临床药理学与治疗学, 2010, 15(8): 916-919.
[15]	熊响清, 金立达, 王良荣, 林丽娜. 异丙酚与瑞芬太尼靶控输注全凭静脉麻醉用于鼻内窥镜手术控制性降压的效果[J]. 中国临床药理学与治疗学, 2010, 15(8): 927-931.