不同血浆靶浓度瑞芬太尼复合异丙酚靶控输注对后腹腔镜手术患者血流动力学的影响  

Effects of Target-controlled Infusion of Remifentanil Combined with Propofol on Hemodynamics in Patients Undergoing Retroperitoneal Laparoscopic Surgery

作　　者：陈晨[1,2] 李璐[3] 陈子墨[4] 

机构地区：[1]河北联合大学附属医院麻醉科,河北省唐山市063000 [2]第七批援尼泊尔医疗队 [3]河北大学附属医院麻醉科 [4]大连医科大学

出　　处：《中国全科医学》2013年第18期2161-2164,共4页Chinese General Practice

摘　　要：目的观察不同血浆靶浓度瑞芬太尼复合异丙酚靶控输注(TCI)对后腹腔镜手术患者血流动力学的影响。方法选2011年6月—2012年12月河北联合大学附属医院收治的择期行后腹腔镜手术患者50例,美国麻醉医师协会(ASA)分级在Ⅰ～Ⅱ级。将患者随机分为两组:瑞芬太尼血浆靶浓度6.0μg/L组(R6组)和8.0μg/L组(R8组),每组25例。麻醉诱导:初始血浆靶浓度异丙酚设定为1.0 g/L,瑞芬太尼设置在3.5μg/L;麻醉维持中两组异丙酚血浆靶浓度均设定为3.0 g/L,R6组和R8组瑞芬太尼血浆靶浓度分别为6.0μg/L和8.0μg/L且恒定不变。记录两组患者基础(T0)、切皮即刻(T1)、气腹后即刻(T2)、气腹后30 min(T3)、气腹后60 min(T4)、气腹结束时(T5)各时点的脑电双频指数(BIS)、平均动脉压(MAP)、心率(HR)、心搏出量(CO)、体循环血管阻力(TSVR)及中心静脉压(CVP),计算每搏量变异度(SVV)。结果两组患者T1～5的BIS值均较T0时降低,差异有统计学意义(P<0.01);且R8组患者T1～2的BIS值,T1～5的MAP,T2-5的HR均较R6组降低,差异有统计学意义(P<0.05);而两组不同时点CO、TSVR、CVP、SVV比较,差异均无统计学意义(P>0.05)。结论在后腹腔镜手术中,瑞芬太尼8.0μg/L复合异丙酚3.0μg/L TCI,较瑞芬太尼6.0μg/L能显著抑制刺激引起的BIS值升高;且可维持术中血流动力学稳定性,从而获得较为满意的麻醉效果。Objective To observe the effects of target - controlled infusion of remifentanil combined with propofol onhemodynamics in patients undergoing retroperitoneal laparoscopic surgery. Methods 50 ASA class I or II patients undergoing ret-roperitoneal laparoscopic surgery admitted from June 2011 to December 2012 were randomly divided into two groups ： the targetplasma concentration of remifentanil was 6. 0 μg/L （ group R6 ） and 8. 0μg/L （ group R8 ）,with each group 25 cases. The target plasma concentration of propofol was set at 1. 0 μg/L, while the concentration of remifentanil was 3. 5 μg/L. And duringmaintaining of anesthesia,the target plasma concentration of propofol was 3. 0 g/L in two groups,while the concentration ofremifentanil was 6. 0 μg/L and 8. 0 μg/L respectively. The BIS, MAP, HR, CO, TSVR, CVP were recorded before induction（T0 ）,when the skin was incised （T1）,immediately after （ T2 ）,30 minutes after （ T3 ）,60 minutes after （ T4 ）,and theend of pneumoperitoneum （T5 ） . The SVV was calculated simultaneously. Results BIS values were remarkably decreased afteranesthesia in two groups （P 〈0. 01 ） . Moreover,BIS values at and T2,MAP at to T5 and HR at T2 to T5 were significantlylower in group R8 than those in group R6 （P 〈0. 05） . CO, TSVR, CVP and SVV were not significantly different between twogroups at each time （ P 〉 0. 05 ） . Conclusion During the retroperitoneal laparoscopic surgery,the increase of BIS value induced is significantly inhibited by the combination of remifentanil （8. 0 μg/L） TCI with propofol （3. 0μg/L）,and may sustainthe hemodynamics stability and obtain satisfactory anesthesia effect.

关 键 词：瑞芬太尼 异丙酚 靶控输注 后腹腔镜手术 血流动力学 

分 类 号：R971.2[医药卫生—药品]