中文摘要：

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2μg/kg,泵速为1μg·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。

英文摘要：

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.