复合不同靶浓度异丙酚时瑞芬太尼引起神经外科手术病人呼吸抑制的效应室浓度  

Respiratory depression effect-site concentration of remifentanil used in combination with different target concentrations of propofol in patients undergoing neurosurgical surgery

作　　者：董佳[1] 王保国[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050

出　　处：《中华麻醉学杂志》2009年第9期796-799,共4页Chinese Journal of Anesthesiology

摘　　要：目的确定复合不同靶浓度异丙酚时瑞芬太尼引起神经外科手术病人呼吸抑制的效应室浓度。方法择期拟行神经外科手术的病人80例，年龄18～64岁，体重45～90kg，随机分为4组（n=20）：瑞芬太尼组（R组）、瑞芬太尼复合异丙酚1μg／ml（RP1组）、瑞芬太尼复合异丙酚1．5μg／ml（RP1.5组）和瑞芬太尼复合异丙酚2μg／nd（RP2组）组。R组、RP1组、RP1.5组和RP1组靶控输注异丙酚，血浆靶浓度分别为0、1、1．5、2μg／ml，达到预设的浓度后，靶控输注瑞芬太尼，初始血浆靶浓度为2ng／ml，随后每3min增加瑞芬太尼血浆靶浓度2ng／ml，直至发生呼吸抑制。记录呼吸抑制时瑞芬太尼效应室浓度、瑞芬太尼用量和其他不良反应发生情况。结果R组、RPI组、RE，组和RR组呼吸抑制时瑞芬太尼效应室浓度分别为（5．2±2．1）、（3．2±1．0）、（2．9±1．3）和（2．2±1．0）ng／ml。与R组比较，RP1组、RP1.5组和RP1组呼吸抑制时瑞芬太尼效应室浓度降低（P〈0．01）；与RP1组和RP1.5组比较，RP2组呼吸抑制时瑞芬太尼效应室浓度降低（P〈0．01）；RP1组和RP1.5组呼吸抑制时瑞芬太尼效应室浓度比较差异无统计学意义（P〉0．05）。结论神经外科手术病人清醒状态下瑞芬太尼效应室浓度为（5．2±2．1）ng／ml时可发生呼吸抑制；复合血浆靶浓度1、1．5、2μg／ml异丙酚镇静时，瑞芬太尼引起呼吸抑制的效应室浓度分别降至（3．2±1．0）、（2．9±1．3）和（2．2±1．0）ng／ml。Objective To determine the respiratory depression effect-site concentration （Ce） of remifentanil when used in combination with different target concentrations of propofol in patients undergoing neurosurgical surgery. Method Eighty patients aged 18-64 yr weighing 45-90 kg scheduled for elective neurosurgical surgery were randondy divided into 4 groups （n = 20 each ）： remifentanil group （group R ）, remifentanil combined with propofol 1, 1.5, 2 μg/ml group （group RP1 , RPI.5 , RP2 ）. In group R, RP1 , RP1.5 or RP2, the patients received propofol by TCI at target plasma concentration （Cp） of 0, 1, 1.5 or 2 μg/ml respectively, when the preset concentration was reached, received remifentanil via TCI at the initial target Cp of 2 ng/ml, and the concentration was then increased in the increment of 2 ng/nd at 3 min intervals until respiratory depression was achieved. Respiratory depression was defined as one of the following end points： muscle rigidity, RR〈6 bpm, MV 〈 3 L/min, PET CO2〉 55 mm Hg, SpO2 〈 90% or apnea 〉 15 s. The Ce of remifentanil, amount of remifentanil used and side effects were recorded during respiratory depression. Result The respiratory depression Ce of remifentanil were （5.2 ± 2.1）, （3.2 ± 1.0）, （2.9 ± 1.3） and （2.2 ± 1.0） ng/ml in group R, RP1 , RP1.5 and R2 respectively. Compared with group R, the respiratory depression Ce of remifentanil were significantly decreased in group RP1, RP1.5 and RP2 （ P 〈 0.01 ） . Compared with group RP1 and RP1.5 , the respiratory depression Ce of remifentanil was significantly decreased in group RP2 （ P 〈 0.01 ）. There was no significant difference in respiratory depression Ce of remifentanil between group RP1 and RP1.5 （P 〉 0.05）. Conclusion The respiratory depression Ce of remifentanil is （5.2 ± 2.1 ） gg/ml in patients without sedation. The respiratory depression Ces of remifentanil are （3.2± 1.0）, （2.9± 1.3） and （2.2 ± 1.0） ng/ml in patients under sedation with propofol at

关 键 词：哌啶类 呼吸功能不全 二异丙酚 药物释放系统 

分 类 号：R614[医药卫生—麻醉学]