亚效应室浓度丙泊酚对术中唤醒过程外显记忆与血流动力学的影响  

Effects of Sub-target Concentrations of Propofol on Explicit Memory and Hemodynamics During Intraoperative Awakening

作　　者：郭瑞[1] 曾丽蓉[1] 何婉雯[1] 王立勋[1] 零达尚[1] 李瑞钰[1] 

机构地区：[1]南方医科大学附属小榄人民医院麻醉科,中山528415

出　　处：《医药导报》2014年第7期895-899,共5页Herald of Medicine

基　　金：广东省中山市科技计划项目(20113A040)

摘　　要：目的：观察一定效应室浓度瑞芬太尼背景下,不同亚效应室浓度丙泊酚对术中唤醒的影响,探寻丙泊酚合理的亚效应室浓度。方法150例ASA分级I或Ⅱ级患者,随机分为R1-R5组各30例。唤醒前均调整瑞芬太尼靶控输注（TCI）浓度为2.4μg·L-1并复合输注丙泊酚：对照组R1输注等量0.9%氯化钠注射液；各观察组TCI丙泊酚,R2组0.5 mg·L-1,R3组1.0 mg·L-1,R4组1.5 mg·L-1,R5组2.0 mg·L-1。观察调整丙泊酚即刻（t0）、唤醒开始即刻（t1）、应答期（ t2）、唤醒结束静脉注射丙泊酚后5 min（ t3）时的平均动脉压（ MAP）、心率（ HR）及Narcotrend Index （ NI）以及唤醒时间（t）,并随访术后外显记忆消除情况。结果①R1、R2、R3组唤醒时间及NI差异无统计学意义（P〉0.05）,R4、R5组NI低于前3组（P〈0.05）,唤醒时间则长于前3组（P〈0.05）。②R3、R4、R5组MAP、HR及外显记忆差异无统计学意义（P〉0.05）,并均低于R1、R2组（P〈0.05）。结论靶控输注瑞芬太尼2.4μg·L-1并复合输注丙泊酚1.0 mg·L-1时不影响唤醒可控性,循环更理想、稳定,能更好地消除患者术后对唤醒过程的外显记忆。Objective To compare the effects of five different target-controlled concentrations of propofol combined with finite concentration of remifentanil on intraoperative awareness,so as to determine the safer and more effective concentration of propofol which could decrease explicit memory and reduce the incidence of intraoperative awareness. Methods One hundred and fifty patients （ ASAⅠ-Ⅱ） were randomly divided into five groups. There was no significant difference between each group in general condition. Before awaking,the target controlled concentration of remifentanil was adjusted to 2. 4 μg·L-1 in all five groups. Groups R1,R2,R3,R4 and R5 also received 0. 9%normal saline,0. 5 mg·L-1,1. 0 mg·L-1,1. 5 mg·L-1 and 2. 0 mg·L-1 of target controlled infusion （ TCI） of propofol, respectively. Narcotrend index （ NI）, mean arterial pressure （MAP）,heart rate （HR） and t [the time from t1（the time of awareness beginning） to the end of awareness] at t0（the time of adjusting propofol）,t1,t2（the period of awareness）,t3（wake period end 5 min） were recorded. Elimination of explicit memory after surgery was followed up. Results There were no significant differences in t and NI between groups R1,R2 and R3（P〉0. 05）. NI of groups R4 and R5 was significantly lower than that in groups R1,R2 and R3（P〈0. 05）,but t of groups R4 and R5 was longer than that in the other groups （P〈0. 05）. The MAP,HR and explicit memory of groups R3,R4 and R5 were lower than those in groups R1 and R2 （P〈0. 05）,but there were no significant differences between groups R3,R4 and R5 （P〉0. 05）. Conclusion Target controlled infusion of remifentanil 2. 4μg·L-1 combined with TCI propofol 1. 0 mg·L-1 does not affect the wakening controllability. The circulation was steadier and explicit memory could be eliminated during intraoperative awakening.

关 键 词：丙泊酚 术中唤醒 NI指数 血流动力学 外显记忆 

分 类 号：R971.2[医药卫生—药品]