固定瑞芬太尼用量调节丙泊酚用量控制MAP与固定丙泊酚用量调节瑞芬太尼用量控制MAP麻醉效果比较  

Comparison of anesthesia effect between fixing dosage of remifentanil with regulating dosage of propofol and fixing dosage of propofol with regulating dosage of remifentanil for MAP controlling

作　　者：刘华[1] 袁承城[1] 吕东森[1] 周骞[1] 康力[1] 刘焕结[1] 罗芬 

机构地区：[1]广东省深圳市宝安区中医院,广东深圳518133

出　　处：《现代中西医结合杂志》2016年第28期3101-3106,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市宝安区科技创新局2014年科研立项资助项目(2014111)

摘　　要：目的观察比较中青年患者接受择期手术实施静脉复合全麻过程中,恒速泵注不同剂量瑞芬太尼调节丙泊酚泵速控制MAP与恒速泵注不同剂量丙泊酚调节瑞芬太尼泵速控制MAP全麻维持方法的麻醉效果。方法选择接受择期手术需实施全麻的中青年患者390例,随机分为13组,每组30例。全麻诱导后,维持麻醉分为恒速泵注不同剂量瑞芬太尼调节丙泊酚用量控制维持MAP（简称RB法）和恒速泵注不同剂量丙泊酚调节瑞芬太尼用量控制维持MAP（简称BR法）2种方法。RB法设6组,瑞芬太尼泵速分别为60μg/（kg·h）（R_（60）组）、55μg/（kg·h）（R_（55）组）、50μg/（kg·h）（R_（50）组）、45μg/（kg·h）（R_（45）组）、40μg/（kg·h）（R_（40）组）、30μg/（kg·h）（R_（30）组）,丙泊酚起始泵速3 mg/（kg·h）,调节丙泊酚泵速控制维持MAP比基础MAP降低〉0~10%（含15例降〉0~5%和15例降〉5%~10%）。BR法设7组,丙泊酚泵速分别为10 mg/（kg·h）（B_（10）组）、8 mg/（kg·h）（B_8组）、7 mg/（kg·h）（B_7组）、6 mg/（kg·h）（B_6组）、5 mg/（kg·h）（B_5组）、4 mg/（kg·h）（B_4组）、3 mg/（kg·h）（B_3组）,瑞芬太尼起始泵速60μg/（kg·h）,调节瑞芬太尼泵速控制维持MAP比基础MAP降低〉0~10%（含15例降低〉0~5%和15例降低〉5%~10%）。13组控制性降压均在手术结束前5min停止。结果 12种方法均能达到把维持MAP控制并维持在比其基础MAP降低〉0~10%的效果,2种方法中各组的HR随着MAP的降低而被动降低,降低的HR对阿托品的增加心率作用敏感,麻醉中按需静注适量阿托品能把HR维持在55次/min以上。2在达到同一控制范围的维持MAP时,BR法各组（除B_6、B_7、B_8组间瑞芬太尼用量相近外）与RB法各组均表现为丙泊酚用量与瑞芬太尼用量呈现负相关（r=-0.91和r=-0.94,P〈0.05）;瑞芬太尼用量与睁眼时间无关;丙泊酚用量与睁眼时�Objective It is to compare anesthetic effect of two methods of general anesthesia maintenance in general anesthesia of young and middle aged selective operation. One method isdifferent dose of remifentanil fixed and the dose of propofol adjusted to control MAP,another is the dose of propofol fixed and the dose of remifentanil adjusted. Methods 390 young and middle aged patients who get selective surgery with general anesthesia were selected and divided into 11 groups randomly. Induction： 13 groups was according to relevant references. Maintenance： There were two methods. One method isthedifferent dose of remifentanil fixed and the dose of propofol adjusted to control MAP（ RB for short）,another was the different dose of propofol fixed and the dose of remifentanil adjusted（ BR for short）. RB was divided into six groups in which the dose of remifentanil was 60 μg /（ kg·h）（ group R_（60））,55 μg/（ kg·h）（ group R_（55））,50 μg/（ kg·h）（ group R_（50））,45 μg/（ kg·h）（ group R_（45））,40 μg/（ kg·h）（ group R_（40）） and 30 μg/（ kg·h）（ group R_（30））. The initial dose of propofol was 3 mg/（ kg·h）. Adjust the dose of propofol to main the MAP which was about 0- 10% lower than the basal MAP（ including 15 cases of which MAP was 0- 5% lower than the basal MAP and 15 cases of which MAP was 5- 10% lower than the basal MAP）. BR was divided into 7 groups in which the dose of propofol was 10 mg /（ kg·h）（ group B_（10））,8 mg/（ kg·h）（ group B_8）,7 mg/（ kg·h）（ group B_7）,6 mg/（ kg·h）（ group B_6）,5 mg/（ kg·h）（ group B_5）,4 mg/（ kg·h）（ group B_4） and 3 mg/（ kg·h）（ group B_3）. The initial dose of remifentanil was 60 μg/（ kg·h）. Adjust the dose of remifentanil to main the MAP which was about 0- 10% lower than the basal MAP（ including 15 cases of which MAP was 0- 5% lower than the basal MAP and 15 cases of which MAP was 5- 10% lower than the basal MAP）. Controlling hyperten

关 键 词：瑞芬太尼 丙泊酚 全麻维持 维持效果 

分 类 号：R614[医药卫生—麻醉学]