Effect of remifentanil with and without atropine on heart rate variability and RR interval in children
Effect of remifentanil with and without atropine on heart rate variability and RR interval in children
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DOI：
10.1111/j.1365-2044.2005.04298.x
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发表时间：
2005-10-01
期刊：
影响因子：
10.7
通讯作者：
Wodey, E
中科院分区：
文献类型：
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作者：
Tirel, O;Chanavaz, C;Wodey, E
瑞芬太尼可通过激活副交感神经或其他负性变时作用引起心动过缓。心率变异性（HRV）的高频（HF）分量是副交感神经活动的标志。本研究旨在评价瑞芬太尼对儿童RR间期和HRV的影响。在人类研究委员会批准并获得父母知情同意后，对40名阿萨I或II级儿童进行了研究。在七氟烷1 MAC下稳定后，将其随机分为两组：一组接受20 mug.kg注射液（AT + REMI），另一组接受乳酸林格液（REMI）。3分钟后，g.kg在1分钟内给予1 μ（-1）推注瑞芬太尼，随后以0.25 μ g. kg（-1）.min（-1）持续输注10分钟，再增加至0.5 μ g. kg（-1）.min（-1）持续10分钟。（0.04-0.15 Hz; LF）和高频率（0.15-0.45 Hz; HF），而RR间期连续差异的均方根（rmssd）直接来自时间序列。统计分析采用多重对应分析和非参数检验。瑞芬太尼诱导RR间期延长，即心动过缓，在这两个组相比，治疗前的值，并与HF和rmssd的增加，只有REMI组。阿托品对副交感神经的抑制不能完全阻止瑞芬太尼的负性变时作用。瑞芬太尼的直接负性变时作用。
Remifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 mu g.kg(-1) atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 mu g.kg(-1) bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 mu g.kg(-1).min(-1) for 10 min increased to 0.5 mu g.kg(-1).min(-1) for a further 10 min. A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.