异丙酚和瑞芬太尼靶控输注静脉麻醉的临床应用  

Target-controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy

作　　者：李敏[1] 吴民慧[1] 薛张纲[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《上海医学》2005年第11期923-925,共3页Shanghai Medical Journal

摘　　要：目的观察异丙酚、瑞芬太尼靶控输注(TCI)静脉麻醉用于腹腔镜胆囊切除术的临床效应.方法选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行腹腔镜胆囊切除术的患者40例,年龄＜65岁,随机均分为芬太尼(F)组和瑞芬太尼(R)组.患者均不予术前用药.入室后开放上肢静脉,监测生命体征、脑电双频指数(BIS)和听觉诱发电位指数(AAIs).异丙酚、瑞芬太尼TCI采用Base Primea麻醉输注工作站给药.两组患者均予异丙酚3μg/ml血浆TCI.F组诱导时予芬太尼4μg/kg、手术开始时予2μg/kg静脉推注;R组以瑞芬太尼6 ng/ml血浆TCI维持;手术结束停止输注两药.观察麻醉诱导、气管插管、手术中、停药时和苏醒时的血压、心率、BIS、AAIs值,记录唤之睁眼时间、拔管时间、苏醒后的不良反应及患者满意度等.结果R组诱导期的血压、心率明显低于F组(P＜0.05).两组患者各时段BIS、AAIs值的差异无显著性(P＞0.05).两组患者均无术中知晓,苏醒时间的差异无显著性(P＞0.05),R组拔管后需阿片类药镇痛的发生率明显高于F组(P＜0.05).结论异丙酚3μg/ml、瑞芬太尼6 ng/ml血浆TCI静脉麻醉能安全、有效地用于腹腔镜胆囊切除术,诱导迅速,能有效抑制插管反应,麻醉过程平顺.由于瑞芬太尼半衰期短,术后应及时予阿片类镇痛药.Objective To evaluate the clinical response of target-controlled infusion-based anesthesia using remifentanil and propofol. Methods 40 ASA Ⅰ-Ⅱ patients （21 male, 19 female） aged 〈65 yr undergoing elective laparoscopic choleeystectomy were randomly divided into two groups： group F and R, each 20 patients, without any preoperative medication in group F the target plasma concentration of propofol was set at 3μg/ml and fentanyl at 4μg/kg during induction and 2μg/kg at the start of operation. In group R, the anesthesia was induced and maintained with TCI propofol-remifentanil which was stopped at the end of the operation. The target plasma concentration of propofol was set at 3μg/ml and remifentanil at 6 ng/ml. The TCI system of Base Primea was used, including Marsh and Minto pharmacokinetic parameters. MAP, HR, EKG, BIS and AAIs were monitored during the anesthesia. The followings were recorded： ①changes in MAP, HR, EKG, BIS and AAIs during anesthesia; ②recovery of spontaneous breathing and orientation after termination of anesthesia;③postoperative outcome, pain and complications including nausea, vomiting and awareness during the operations. Results Dur ing induction MAP, the HRs were significantly lower in group R than in group F （P〈0.05）. BIS and AAIs during operation were not significantly different. The duration from termination of anesthetics to full recovery of spontaneous breathing, eye opening at request and tracheal extubation were similar between the two groups. Pain after operation was significantly higher in group R than that in group F. Conclusions Anesthesia with the target plasma propofol concentration of 3μg/ml in the presence of plasma remifentanil of 6 ng/m is safe and effective. It can effectively attenuate the intubation response. Because of the shorter context-sensitive half life of remifentanil, postoperative analgesia should be started earlier.

关 键 词：异丙酚 哌啶类 药物投射系统 麻醉 静脉内 

分 类 号：R614[医药卫生—麻醉学]