靶控输注与静脉输注瑞芬太尼复合异丙酚用于局部麻醉患者镇静镇痛术效应的比较  

Sedative and analgesic effects of remifentanil combined with propofol administered by TCI versus intravenous infusion during local anesthesia

作　　者：刘孝文[1] 邓晓明[1] 王烨[1] 王磊[1] 隋静湖[1] 孙玉蕾[1] 

机构地区：[1]100144中国医学科学院北京协和医学院整形外科医院麻醉科

出　　处：《中华麻醉学杂志》2012年第5期622-625,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较靶控输注与静脉输注瑞芬太尼复合异丙酚用于局部麻醉患者镇静镇痛术的效应。方法局部麻醉辅助镇静镇痛术下择期整形外科手术的患者60例，年龄18～55岁，体重指数〈30kg／m2，ASA分级I或Ⅱ级，采用随机数字表法，将患者随机分为2组（n=30）：静脉输注组（V组）和靶控输注组（T组）。T组局部麻醉前靶控输注瑞芬太尼（初始靶浓度1．0ng／m1）和异丙酚（初始靶浓度1．0gg／m1），V组瑞芬太尼静脉负荷剂量0．25gg／kg，维持速率0．05μg·kg^-1·min^-1，异丙酚负荷剂量0．5mg／kg，维持速率3mg·kg^-1·h^-1。术中调整靶浓度或输注速度以维持改良的OAA／S评分2或3分，术中记录低氧血症、呼吸过缓和／或暂停的发生情况，计算异丙酚和瑞芬太尼的总用量。结果与V组比较，T组术中低氧血症、呼吸过缓和／或暂停的发生率明显降低，异丙酚和瑞芬太尼总用量明显减少（P〈0．05）。结论靶控输注瑞芬太尼复合异丙酚用于局部麻醉患者镇痛镇静术具有良好的安全性且效应优于静脉输注。Objective To compare the sedative and analgesic effects of remifentanil combined with propofol administered by target-controlled infusion （TCI） and intravenous infusion during local anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 18-55 yr, with body mass index 〈 30 kg/m2 , scheduled for plastic surgery under local anesthesia, were equally and randomly divided into TCI group （group T） and intravenous infusion group （group V）. Rcmifentanil （the initial target plasma concentration 1.0 ng/ml） and propofol （the initial target plasma concentration 1.0 ng/ml） were given by TCI before local anesthesia in group T. Remifentanil was infused at a rate of 0.05 μg·kg ^-1·min^-1 after a loading dose of 0.25 μg/kg and propofol was infused at a rate of 3 mg· kg^- 1· h^-1 after a loading dose of 0.5 mg/kg in group V. The target plasma concentration or infusion rate was adjusted to ma- intain the modified OAA/S score of 2 or 3. Hypoxemia, bradypnea and/or apnea were recorded during operation. The total amount of remifentanil and propofol consumed was calculated. Results Compared with group V, the incidence of hypoxemia, bradypnea and/or apnea were significantly decreased during operation, and the total amount of remifentanil and propofol consumed was significantly reduced in group T （ P 〈 0.05） . Conclusion The sedative and analgesic effects of remifentanil combined with propofol given by TCI are superior to those given by intravenous infusion during local anesthesia, with better safety.

关 键 词：镇痛药 阿片类 二异丙酚 药物释放系统 清醒镇静 镇痛 

分 类 号：R614[医药卫生—麻醉学]