妇科腹腔镜手术中不同血浆靶浓度瑞芬太尼对异氟醚MAC_(BAR)的影响  

Effects of different target Plasma remifentanil concentrations on MAC_(BAR) of isoflurane in gynecological patients undergoing laparoscopic surgery

作　　者：谭丽娟[1] 苏靖诚[1] 潘露菲[1] 宋恺颖[1] 李明惠[1] 谭宪湖[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,广西南宁530021

出　　处：《蛇志》2012年第4期356-357,360,共3页Journal of Snake

摘　　要：目的观察妇科腹腔镜CO2气腹快速充气阶段不同血浆靶浓度瑞芬太尼对异氟醚MACBAR的影响。方法将120例全麻下行妇科腹腔镜手术患者按瑞芬太尼血浆靶浓度随机分为4组:R0组(0ng/ml)、R1组(1ng/ml)、R2组(2ng/ml)和R3组(3ng/ml)。4组麻醉诱导药物:依托咪酯0.3mg/kg、顺阿曲库铵0.2mg/kg及血浆靶控瑞芬太尼(3ng/ml)。患者气管插管后吸入异氟醚,R0组停用瑞芬太尼,R1、R2、R3组以瑞芬太尼1ng/ml、2ng/ml、3ng/ml的血浆靶浓度靶控输注。根据每组患者CO2气腹快速充气阶段HR或MAP的变化采用序贯法对异氟醚MACBAR进行测定,同时观察气腹前后BIS值与血流动力学改变的关系。结果各组异氟醚MACBAR分别为:R0组(1.63±0.05)%,R1组(1.03±0.06)%,R2组(0.71±0.07)%,R3组为(0.58±0.06)%。结论异氟醚MACBAR随着瑞芬太尼血浆靶浓度的增加逐渐降低,有出现封顶效应的趋势。Objective To investigate the effects of different targeted plasma remifentanil concentrations on MACBAR of isoflurane in gynecological patients undergoing rapid inflation period of laparoscopic surgery using car- bon dioxide pneumoperitoneum. Methods 120 gynecological patients undergoing elective laparoscopic surgery under general anesthesia, were randomly divided into 4 groups accorded to different redmifentanil target plasma concentrations： group R0 （0 ng/ml） ,group R1 （1 ng/ml） ,group R2 （2 ng/ml） and group R3 （3 ng/ml）. Four groups of anesthesia induction drugs：etomidate 0.3 mg/kg,cisatracuriun besilate 0.2 mg/kg and target plasma concentra- tion of remifentanil （3 ng/ml）. After intubation anesthesia was maintained with isoflurane in all groups. But in R0, R1,R2 and R3, the targeted plasma concentration of remifentanil was adjusted to 0 ng/ml, 1 ng/ml, 2 ng/ml and 3 ng/ml. According to the patients change of HR or MAP during rapid inflation period of pneumoperitoneum stimu- lation. Predetermined end-tidal isoflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential allocation technique. Results In group R0, R1 , R2 and R3, the MACBAR s of isoflurane were （1. 63±0. 05）% ,（1.03±0. 06）%,（0. 71±0. 07）% ,（0. 58±0. 06）%. Conclusion Remifentanil might de- crease MACBAR of isoflurane obviously with ceiling effect.

关 键 词：腹腔镜 瑞芬太尼 异氟醚 MACBAR BIS 

分 类 号：R735.37[医药卫生—肿瘤]