靶控输注普鲁泊福复合芬太尼或瑞芬太尼的麻醉深度比较  

Target-controlled infusion of propofol combined with remifentanil or fentanyl: a comparison of anesthetic depth

作　　者：张中军[1] 杨立群[2] 彭玉梅[1] 方明[1] 李荣[1] 李泉[2] 俞卫锋[2] 

机构地区：[1]江苏省无锡市第三人民医院麻醉科,无锡214041 [2]第二军医大学东方肝胆外科医院麻醉科,上海200438

出　　处：《第二军医大学学报》2006年第3期289-291,共3页Academic Journal of Second Military Medical University

摘　　要：目的:比较靶控输注普鲁泊福复合瑞芬太尼或芬太尼的麻醉深度和术后恢复情况。方法:90例择期上腹部手术患者,随机分为普鲁泊福-芬太尼A组(PF-A)、普鲁泊福-芬太尼B组(PF-B)、普鲁泊福-瑞芬太尼组(PR),每组30例。普鲁泊福靶浓度均为3μg/m l;PF-A组芬太尼靶浓度维持2μg/L;PF-B组芬太尼初始靶浓度为4μg/L,插管后降为2μg/L;PR组瑞芬太尼靶浓度为6μg/L。观察3组患者在麻醉前、气管插管前后、切皮后、术中维持时的平均动脉压(MAP)、心率(HR)、脑电双频指数(B IS),以及患者的麻醉后恢复情况。结果:PF-A组患者在气管插管后,MAP及HR显著高于插管前(P<0.05),有较明显的插管反应,切皮后各指标与插管前比较无显著差异(P>0.05)。PF-B组和PR组患者的各指标在气管插管、切皮后与插管前比较,均无显著性差异(P>0.05)。3组患者麻醉和手术期间各时间点B IS值无显著组间差异(P>0.05)。此外,PR组患者苏醒时间明显较其他组短。结论:4μg/L芬太尼可以有效抑制气管插管反应,而2μg/L芬太尼则会产生明显的插管反应,但可以有效抑制切皮反应;6μg/L瑞芬太尼既可以抑制插管反应又可以抑制切皮反应,获得满意的临床麻醉深度。Objective：To compare the anesthetic depth and postoperative recovery of propofol combined with remifentanil or fentanyl when administered through target-controlled infusion （TCI）. Methods： Ninety patients receiving elective epigastric surgery were randomly divided into 3 groups： PF-A, PF-B and PR group. Through TCI, patients in PF-A group were administered with propofol （3 μg/ml） and fentanyl （2μg/L）, in PF-B group with propofol（3μg/ml） and fentanyl （4 μg/L initially and 2 μg/L after intubation）, and in PR group with propofol （3μg/ml） and remifentanil （6 μg/L）. Vital signs （including mean aortic pressure and heart rate） and bispectral index values were recorded pre-anesthesia, preand post-intubation, post-incision and during operation in 3 groups. Results： In PF-A group, post-intubation MAP and HR were significantly higher than those of pre-intubation （P〈0.05）, with obvious stress response during intubation. Whereas there was no significant difference in all parameters between those pre-intubation and post-incision. The vital signs maintained stable during anesthesia and operation in PF-B and PR groups. There was no significant difference in BIS values between 3 groups. During recovery phase the awakening time of PR group was significantly shorter than those of PF-A and PF-B groups. Conclusion： Clinical administration of 4 μg/L fentanyl or 6 μg/L remifentanil can effectively suppress the hemodynamic response to tracheal intubation and incision in propofol TCI anesthesia. However, 2 μg/L fentanyl is only enough to suppress the response to incision but not to intubation.

关 键 词：普鲁泊福 瑞芬太尼 芬太尼 靶控输注 麻醉 静脉 

分 类 号：R614[医药卫生—麻醉学]