瑞芬太尼对全麻患者丙泊酚靶控输注诱导时血流动力学和脑状态指数的影响  

Influence of remifentanil on hemodynamics and cerebral state index in target-controlled infusion of propofol for anesthesia induction

作　　者：潘松[1] 徐晖[1] 陆松红[1] 吴鸿浩[1] 李勇[1] 

机构地区：[1]蚌埠市第三人民医院麻醉科,安徽蚌埠233000

出　　处：《皖南医学院学报》2011年第6期502-504,共3页Journal of Wannan Medical College

基　　金：蚌埠市科技计划项目(2009-68)

摘　　要：目的:探讨不同剂量瑞芬太尼联合丙泊酚靶控输注诱导时对全麻患者血流动力学和脑状态指数的影响并寻找其在全麻诱导中的合理剂量。方法:44例全麻患者随机分为4组,丙泊酚初始靶浓度设为1.5 mg/L,每4 min增加0.5 mg/L,待MOAA/S为1分时1组输注生理盐水,2、3、4组泵注瑞芬太尼,泵入剂量分别为0.1μg/(kg.min),0.2μg/(kg.min),0.4μg/(kg.min),在MOAA/S为0分时给予阿曲库铵0.6 mg/kg,3 min后行气管插管。记录诱导前(T0),气管插管前即刻(T1),插管后1 min(T2)的心率(HR)、平均动脉压(MAP)、脑状态指数(CSI)变化。结果:4组患者术前基础值无统计学差异,与插管前相比,1、2组患者插管后血压明显升高(P<0.01),且升高幅度大于3、4组。在T1时4组患者血压的下降幅度明显大于其他3组(P<0.01)。4组患者插管前后CSI无统计学差异。结论:瑞芬太尼0.2μg/(kg.min)复合异丙酚靶控输注诱导既可较好地维持心血管系统的稳定性,又可有效抑制气管插管时的心血管反应,是麻醉诱导的较合理剂量。脑状态指数并不能准确预测气管插管期间的心血管反应。Objective：To investigate the effects of different dosage of remifentanil on hemodynamics and cerebral state index（CSI） in patients with general anesthesia during target-controlled infusion（TCI） of propofol for anesthesia induction.Methods：Forty-four patients（ASA I-II） undergoing general anesthesia were randomly allocated to four groups（Group1-4）.Anesthesia induction with TCI started by plasma concentration of propofol with 1.5 mg/L and was increased by 0.5 mg/L every four minutes.Patients in group 1 received infusion of physiological saline when were in sedation（by Modified Observer′s Assessment of Alertness/Sedation Scale;MOAA/S;scoring 1） and group 2,3 and 4 were given remifentanil infusion which dose was set at 0.1,0.2 or 0.4 μg/（kg·min）,respectively.Tracheal intubation was facilitated with 0.6 mg/kg tracrium by MOAA/S scoring 0.The data were kept regarding the mean arterial pressure（MAP）,heart rate（HR） and CSI before induction（T0）,the instance of intubation（T1） and 1min after intubation（T2）.Results：There were no significant differences on CSI among the four groups of patients by each time point,yet,MAP was significantly elevated in group 1 and 2 as compared with group 3 and 4 after tracheal intubation（P0.01）.Still,MAP in group 4 was significantly descended at T1（P0.01）.No statistical difference was seen among the four groups of patients before and after tracheal intubation.Conclusion：Combined use of remifentanil at 0.2 μg/（kg·min） with TCI of propofol induction may relatively lead to stable hemodynamics but less reaction to noxious stimulus.Nevertheless,CSI index is not sensitively to indicate the cardiovascular response during tracheal intubation.

关 键 词：瑞芬太尼 丙泊酚 靶控输注 血流动力学 脑状态指数 

分 类 号：R971.2[医药卫生—药品] R614.2[医药卫生—药学]