丙泊酚复合雷米芬太尼在乳腺区段切除术中的应用  

Application of propofol combined with remifentanil anesthesia for regional adenomammectomy

作　　者：白念岳[1] 郭曲练[1] 王云姣[1] 王月玲[1] 杨胜辉[1] 

机构地区：[1]中南大学附属湘雅医院麻醉科

出　　处：《临床麻醉学杂志》2010年第5期373-375,共3页Journal of Clinical Anesthesiology

摘　　要：目的 观察丙泊酚复合不同靶控浓度雷米芬太尼对乳腺区段切除手术麻醉效果和术后恢复的影响.方法 60例择期行乳腺区段切除手术的患者.随机均分为R1、R2、R3组,雷米芬太尼的靶控浓度分别为2、4、6 ng/ml,丙泊酚靶控浓度为4μg/ml.记录丙泊酚用量、血流动力学、BIS值、术中肢动及术后恢复情况.结果 R2、R3组患者意识消失时间和喉罩置入时丙泊酚总用量明显少于R1组（P〈0.05）.喉罩置入前、后和切皮后R2、R3组的MAP、HR较R1组明显下降和减慢（P〈0.05）;R1组术中肢动的反应和丙泊酚用量明显高于R2、R3组（P〈0.05）;手术结束后自主呼吸恢复时间、呼之睁眼时间、拔除喉罩时间、定向力恢复时间、以及苏醒后VAS评分、恶心呕吐发生率三组间差异均无统计学意义.结论 在乳腺区段切除手术中,靶控输注4μg/ml丙泊酚复合大于4ng/ml的雷米芬太尼可以取得满意的麻醉效果,且术后恢复迅速.Objective To observe the outcomes of anesthesia with propofol combined with remifentanil in regional adenomammeetomy. Methods Sixty patients undergoing selective regional adenomammectomy were randomly divided into three groups with 20 cases each.. Remifentanil in a target-controlled infusion （TCI） concentration of 2 ng/ml（group R1）,4 ng/ml（group R2）,or 6 ng/ml （group R3） were infused, which was combined with TCI of propofol 4μg/ml. Laryngeal mask（LM） was inserted when the value of bispectral index （BIS） dropped below 50. The propofol consumption, hemodynamies, BIS value, body movements during operation and recovery form anesthesia were recorded. Results The time lost consciousness and propofol consumption were less in groups of R2 and R3 than those in group R1 during induction and LM insertion（P〈0.05）. BP and HR during LM insertion were lower in group R2 or R3 than those in group R1 （P〈0. 05）. BP, HR and BIS after skin incision were significantly higher in group R1 than those in groups of R2 and R3（P〈0. 05）. The percentage of body movement and proportion usage during operation were significantly higher in group R1 than those in groups of R2 and R3 （P〈0.05）. There were no significant differences in the times of recoverying spontaneous breath, opening eyes in response to voice, removing LM,VAS score, and the incidence of nausea and vomiting among the three groups. Conclusion Satisfactory anesthetic effect and rapid postoperative recovery can be obtained by combined use of 4μg/ml propofot TCI and remifentanil in a dose more than 4 ng/ml in patients undergoing regional adenomammeetomy.

关 键 词：雷米芬太尼 丙泊酚 靶控输注 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]