瑞芬太尼不同靶浓度对异丙酚全麻诱导期间血流动力学的影响  

Effect of remifentanil at various target plasma concentrations on hemodynamics during induction of general anesthesia with propofol

作　　者：纪宏新[1,2] 张兴安[1] 徐波[1] 安裕文[3] 

机构地区：[1]广州军区广州总医院麻醉科,510010 [2]广东省深圳市龙岗区葵涌人民医院,518119 [3]贵阳医学院附属医院麻醉科,550001

出　　处：《实用医学杂志》2009年第6期952-954,共3页The Journal of Practical Medicine

基　　金：广州市科技攻关计划基金资助(编号:2007Z3-D0031)

摘　　要：目的:比较瑞芬太尼不同靶浓度对异丙酚全麻诱导期间血流动力学的影响,探讨适宜的瑞芬太尼靶浓度。方法:将60例靶控输注(TCI)瑞芬太尼与异丙酚全麻择期手术患者随机分为3组)(均n=20),瑞芬太尼靶浓度分别为2ng/mL(R2组)、4ng/mL(R4组)和6ng/mL(R6组)达到与效应室浓度平衡后TCI异丙酚,每次增加0.50μg/mL,直至患者意识消失后行气管插管。记录麻醉诱导前(T0)、瑞芬太尼达血浆-效应室平衡时(T1)、睫毛反射消失时(T2)、意识消失时(T3)、气管插管前即刻(T4)、气管插管后1min(T5)、3min(T6)、5min(T7)时SBP、DBP、HR。结果:与T0比较,R2组HR、SBP、DBP在T2-T4降低,T5升高,R4、R6组HR在T1-T4、T7降低,SBP、DBP在T2-T7降低(P<0.05或P<0.01);与R2组比较,R4、R6组HR在T1-T2、T5-T7降低(P<0.05),SBP、DBP在T5-T7降低(P<0.01)。R6组心动过缓和胸壁肌僵的发生率多于R2、R4组。结论:异丙酚复合瑞芬太尼靶浓度4ng/mL全麻诱导期间血流动力学平稳,能较好消除气管插管反应,不良反应少。Objective To compare the effects of remifentanil at various target plasma concentrations on hemodynamics during induction of general anesthesia with propofol. Methods Sixty patients undergoing elective surgery were randomized to receive target-controlled infusion （TCI） of remifentanil of 2, 4, or 6 ng/mL（group R2, R4, or R6, respectively; n = 20）. After the blood-effect site concentrations of remifentanil were equilibrated, all the patients received TCI of propofol, with an increment of 0.50μg/mL each time, until they were unconscious and received endotracheal intubation. In each group, SBP, DBP, and HR were monitored at pre-induetion （T0） ; blood-effect site equilibration （T1） ; loss of eyelash reflex （T2） ; loss of consciousness （T3） ; the moment before intubation （T4） ; 1 min （T5）, 3 min （T6）, and 5 min （T7） after intubation. Results As compared with To, HR, SBP, and DBP in group R2 were decreased at T2 to T4 and increased at T5 significantly; HR in groups R4 and R6 was declined at T1 to T4 and T7, so were SBP and DBP at T2 to T7 （P 〈 0.05 or P 〈 0.01 ）. As compared with group R2, HR at T1 to T2 and T5 to T7 was decreased in groups R4 and R6 （P 〈 0.05）, so were SBP and DBP at T5 to T7 （P 〈 0.01 ）. The incidence rates of bradycardia and muscle rigidity were more frequent in groups R4 and R6 than in group R2. Conclusions A remifentanil target concentration of 4 ng/mL in combination with propofol for induction of anesthesia can maintain stable hemodynamics and reduce responses to intubation and it has fewer adverse events.

关 键 词：麻醉和镇痛 二异丙酚 药物释放系统 血流动力学过程 

分 类 号：R614.2[医药卫生—麻醉学]