瑞芬太尼在全麻联合硬膜外麻醉行腹腔镜胆囊切除术29例  

Clinical application of Remifentanil to combined general-epidural anesthesia in 29 cases receiving cholecystectomy under laparoscope

作　　者：王学斌[1] 高军[1] 曾玲双[1] 李忠田[1] 

机构地区：[1]银川市第一人民医院麻醉科,宁夏银川750001

出　　处：《第四军医大学学报》2005年第8期724-726,共3页Journal of the Fourth Military Medical University

摘　　要：目的: 观察瑞芬太尼复合丙泊酚在全麻硬膜外联合麻醉中的麻醉效果,序贯法测定瑞芬太尼的半数有效量.方法: 腹腔镜胆囊切除术29例.硬膜外(T89)穿刺成功后硬膜外腔注入实验剂量局麻药.静脉快速诱导,丙泊酚效应室浓度1.5 mg/L输注、瑞芬太尼1 μg/kg注射后以序贯法输注瑞芬太尼,输注速度分别为150.0,135.5,122.5,110.7,100.0 ng/(kg·min);气管插管并控制呼吸,硬膜外腔再追加20 mL/L利多卡因3～5 mL.结果: 序贯法测定瑞芬太尼输注其ED50为108.3～118.1 ng/(kg·min).麻醉后血压下降(P=0.002),心率减慢(P=0.024),气管插管后血压和心率的变化小.结论: 瑞芬太尼1.0 mg/L负荷量注射后以略高于0.10 μg/(kg·min)的速率输注,丙泊酚以1.5 mg/L靶浓度输注,可满足硬膜外阻滞复合全身麻醉下腹腔镜胆囊切除术的需要.AIM: To observe the effect of Remifentanil used with Propofol in combined general-epidural anesthesia and to determine the ED50 of Remifentanil.METHODS: Twenty-nine cases receiving cholecystectomy under laparoscope were enrolled in the study.After the epidural cavity puncture,the patients were fast induced intravenously.The effect compartment concentration of Propofol was 1.5 mg/L and Remifentanil was injected in a dose of 1 μg/kg.Remifentanil was then infused with sequential experimental method,the speed of which was separately 150.0,135.5,122.5,110.7 and 100.0 ng/(kg·min).The patients were intubated and the respiration was controlled.RESULTS: The sequential experiment proved that the ED50 of Remifentanil in these cases was 0.1083 ~ 0.1181 μg /(kg·min).After being anesthetized,the patients' blood pressure was depressed (P=0.002) and the heart rate slowed down(P=0.024).After intubation,the change of their blood pressure and heart rate was minor.CONCLUSION: When Remifentanil is infused at a speed of a little more than 0.10 μg/kg and propofol is infused by a target concentration of 1.5 mg/L,Remifentanil can meet the need of combined general-epidural anesthesia,under which cholecystectomy guided by laparoscope is performed.

关 键 词：瑞芬太尼 EDSO 麻醉 全身 麻醉 硬膜外 

分 类 号：R614[医药卫生—麻醉学]