舒芬太尼靶控输注时不同效应室浓度对复苏质量的影响  

Effect of different effect compartment concentration of sufentanil on recovery quality during anesthesia with sufentanil given by target-controlled infusion

作　　者：邓磊[1] 王两忠[1] 

机构地区：[1]成都大学附属医院麻醉科,成都市610081

出　　处：《临床合理用药杂志》2015年第8期19-20,22,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的探讨舒芬太尼复合丙泊酚靶控输注时舒芬太尼不同效应室浓度对复苏质量的影响。方法选择拟行开胸手术的患者150例,ASAⅠ或Ⅱ级,随机分为Ⅰ组、Ⅱ组、Ⅲ组各50例。所有患者均使用丙泊酚和舒芬太尼靶控输注行全凭静脉麻醉。术毕,舒芬太尼效应室浓度Ⅰ组为0.12ng/ml,Ⅱ组为0.15ng/ml,Ⅲ组为0.20ng/ml。丙泊酚血浆靶浓度均为1.5μg/ml。监测并记录麻醉诱导前(T0)、手术开始后30min(T1)、手术结束时(T2)、拔除气管导管后5min(T3)及术后30min(T4)的心率(HR)、平均动脉压(MAP)。记录患者自主呼吸恢复时间、苏醒时间及拔管时间。评价拔除气管导管后5min(T3)及术后30min(T4)的视觉模拟(VAS)疼痛评分、Ramsay镇静评分。记录术后60min内嗜睡、呼吸抑制、烦躁等不良反应发生率。结果各组患者T3、T4时点较T0、T1、T2时点HR、MAP明显升高(P<0.05)。Ⅰ组在T3、T4时点HR、MAP明显高于Ⅱ组、Ⅲ组(P<0.05)。Ⅲ组的自主呼吸恢复时间、苏醒时间、拔管时间较Ⅰ组、Ⅱ组明显延长(P<0.05)。Ⅱ组、Ⅲ组拔除气管导管后5min及术后30min的视觉模拟(VAS)疼痛评分优于Ⅰ组(P<0.05)。Ⅱ组拔除气管导管后5min及术后30min的Ramsay镇静评分优于Ⅰ组、Ⅲ组(P<0.05)。Ⅱ组术后60min内嗜睡、呼吸抑制、烦躁等不良反应发生率低于Ⅰ组、Ⅲ组(P<0.05)。结论舒芬太尼效应室靶浓度0.15ng/ml复合丙泊酚血浆靶浓度1.5μg/ml最适合麻醉复苏。Objective To explore effect of different effect compartment concentration（ Ce） of sufentanil on recovery quality during anesthesia with sufentanil combined with propofol given by target-controlled infusion（ TCI）. Methods 150 cases of patients scheduled for thoracic surgery,ASA Ⅰ or Ⅱ,were randomly divided into group Ⅰ,group Ⅱ and group Ⅲ,50 cases in each group. Anesthesia was induced and maintained in all patients using target controlled infusion of sufentanil and propofol. At the end of surgery,the Ce of sufentanil was set at 0. 12 ng / ml in group Ⅰ,0. 15 ng / ml in group Ⅱ and 0. 20 ng / ml in group Ⅲ. TCI propofol was maintained at a target plasma concentration of 1. 5ug / ml in the 3 groups. Mean arterial pressure（ MAP）,heart rate（ HR） of 3 groups before induction of anesthesia（ T0）,at 30 min after the beginning of surgery（ T1）,at the end of surgery（ T2）,at 5min after extubation（ T3） and 30 min after the end of surgery（ T4） were monitored. The time of spontaneous breathing,recovery and extubation were recorded. The visual analog scale（ VAS） of postoperative pain and the Ramsay scale at the time of 5min after extubation and 30 min after operation were assessed in 3 groups. In 60 min after extubation,the incidence of somnolence,respiratory depression,delirium were recorded. Results The MAP and HR of all patients at T3,T4 were markedly higher than T0,T1,and T2（ P〈0. 05）. At T3 and T4,the MAP and HR in group Ⅰ were higher than group Ⅱ and Ⅲ（ P〈0. 05）. The time of spontaneous breathing,recovery and extubation in group Ⅲ were significantly longer than that in group Ⅰ or Ⅱ（ P〈0. 05）. The VAS of group Ⅱ and Ⅲ at T3 and T4were better than group Ⅰ（ P〈0. 05）. The Ramsay score at T3 and T4of group Ⅱ were better than Ⅰ and Ⅲ（ P〈0. 05）. In 60 min after extubation,the incidence of postoperative complications were higher than Ⅰ and Ⅲ（ P〈0. 05）. Conclusion The target effect-site sufentanil concentration of

关 键 词：舒芬太尼 靶控输注 苏醒质量 全凭静脉麻醉 

分 类 号：R614[医药卫生—麻醉学]