瑞芬太尼联合异丙酚双通道靶控输注用于心功能Ⅱ～Ⅲ级老年患者的全麻诱导  

General anesthesia by target-controlled infusion of remifentanil in combination with propofol in elderly patients with NYHA Ⅱ～Ⅲ

作　　者：吴惊雷[1] 文莉[1] 曾金[1] 

机构地区：[1]广西柳州市人民医院广西医科大学第五附属医院,广西柳州545001

出　　处：《右江民族医学院学报》2009年第2期177-179,共3页Journal of Youjiang Medical University for Nationalities

摘　　要：目的探讨瑞芬太尼复合异丙酚靶控输注(TCI)全凭静脉麻醉用于心功能Ⅱ～Ⅲ级老年患者全麻诱导的合适效应室靶浓度。方法全麻下心功能Ⅱ～Ⅲ级年龄62～86岁患者择期手术病人60例,随机分为3组,每组20例。入室后(基础值T1)静脉输注乳酸钠林格氏液5ml/kg,效应室靶浓度TCI(T2)3组病人瑞芬太尼从1.0ng/ml分别渐升至2.0ng/ml,3.0ng/ml和4.0ng/ml(T3)后启动异丙酚TCI,从1.0μg/ml血浆靶浓度渐升至4.0μg/ml(T4),气管插管后即刻(T5),气管插管后2min(T6)。记录平均动脉压(MAP)、心率(HR)、双频谱指数(BIS),不良反应发生率、辅助药物使用次数。结果与Ⅰ组比较,Ⅱ组Ⅲ组给药后气管插管时及气管插管后MAP、HR降低(P<0.05),而Ⅱ组、Ⅲ组不良反应次数较Ⅰ组多、麻醉过浅次数较Ⅰ组少(P<0.05),而BISⅠ组较高。结论瑞芬太尼复合异丙酚TCI全凭静脉麻醉用于老年心功能Ⅱ～Ⅲ级患者全麻诱导效应室靶浓度TCI瑞芬太尼宜为3.0ng/ml复合异丙酚TCI4.0μg/ml。Objective To explore target effect - site concentration of remifentanil and propofol target - controlled infusion （TCI） for general anesthesia in elderly patients with NYHA Ⅱ-Ⅲ. Methods 60 patients aged 62 -86 with NYH Ⅱ-Ⅲ undergoing elective surgery were randomly divided into 3 groups, 20 cases in each group. The measurements were obtained at six different time points： T1 = after sodium lactate Ringer＇s solution 5ml/kg was infused, T2 = the target effect - site concentration （1.0ng/ml） of remifentanil was started in three groups, T3 = the target effect - site concentration of remifentanil in groups Ⅰ , Ⅱ and Ⅲ increased to 2.0ng/ml, 3.0ng/mt and 4. 0ng/ml, respectively, T4 = after remifentanil TCI, propofol TCI was started at target plasma concentration of 1. 0μg/ml which was increased to 4.0μg/ml, T5 = when tracheal intubation was started, T6 = 2 minutes after tracheal intubation. Recordings included mean arterial pressure （MAP）, heart rate （HR）, bispectral index （BIS）, incidence of side effects and the frequency of using adjuvants. Results Compared to group Ⅰ , groups Ⅱ and Ⅲ in MAP and HR decreased significantly when tracheal intubation was started and after tracheal intubation （ P 〈 0.05）, and groups Ⅱ and Ⅲ had more side effects than group Ⅰ , and had less use of adjuvants than group Ⅰ （ P 〈0.05）, and the BIS values of group Ⅰ were lower than both of the two groups. Conclusion When general anesthesia of remifentanil in combination with propofol TCI was used in elderly patients with NYHA Ⅰ -Ⅲ, the optional target effect- site concentration of remifentanil TCI was set at 3.0ng/ml in combination with propofol TCI of 4.0μg/ml.

关 键 词：瑞芬太尼 二异丙酚 麻醉 效应室靶浓度 

分 类 号：R614.2[医药卫生—麻醉学]