3个年龄段全麻中瑞芬太尼、丙泊酚最佳配伍维持剂量间量效关系比较  

Comparison on dose effect relationship of remifentanil and propofol with optimal compatibility maintenance dose among three age groups in general anesthesia

作　　者：陈丽[1] 刘华[1] 康力[1] 王珊 袁承城[1] 吕东森[1] CHEN Li;LIU Hua;KANG Li;WANG Shan;YUAN Chengcheng;LYU Dongsen(Shenzhen Baoan District Hospital of Traditional Chinese Medicine , Shenzhen 518133 , Guangdong , China)

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》2018年第15期1603-1606,1610,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的比较老年、中青年、儿童患者静脉复合全麻维持中的瑞芬太尼、丙泊酚最佳配伍量效关系,找出3个年龄段全麻维持效果相同时瑞芬太尼、丙泊酚配伍用量的差异,为临床麻醉提供参考。方法回顾已按照科研计划实施的老年、中青年、儿童全麻患者资料,将3个年龄段各自全麻维持效果最佳的一组分别定为老年组(L组,15例)、中青年组(Z组,30例)、小儿组(X组,20例)。全麻诱导:L组泵注依托咪酯0.15 mg/kg、瑞芬太尼15μg/kg,同时静注阿托品0.007 mg/kg、维库溴铵0.12 mg/kg;Z组泵注依托咪酯0.3 mg/kg、瑞芬太尼15μg/kg,同时静注阿托品0.007 mg/kg、维库溴铵0.12 mg/kg;X组泵注丙泊酚1.5 mg/kg、瑞芬太尼15μg/kg,同时静注阿托品0.008 mg/kg、维库溴铵0.12 mg/kg。全麻维持:L组恒速泵注瑞芬太尼50μg/(kg·h),调节丙泊酚用量控制并维持麻醉中MAP(简称维持MAP)比其基础MAP降低5%(0~10%)左右;Z组和X组均是恒速泵注丙泊酚5 mg/(kg·h),调节瑞芬太尼用量控制并维持麻醉中MAP比其基础MAP降低5%左右。3组均在手术结束前5 min停止降压。结果 3组全麻维持效果评级均达到Ⅰ级,3组间维持MAP平稳指数比较差异无统计学意义(P均>0.05);3组维持MAP平稳指数比基础MAP平稳指数均在36.70%~68.30%;3组间睁眼时间比较差异无统计学意义,均无清醒躁动及术中知晓病例出现。X组实际瑞芬太尼用量明显多于L组和Z组(P均<0.05),L组实际丙泊酚用量明显少于X组和Z组(P均<0.05)。结论 3个年龄段达到同样的全麻维持效果Ⅰ级时,儿童患者瑞芬太尼用量多于老年和中青年患者,老年患者丙泊酚用量少于儿童和中青年患者。儿童、中青年患者应采用固定丙泊酚用量调节瑞芬太尼用量控制MAP的麻醉用药方法,老年患者应采用固定瑞芬太尼用量调节丙泊酚用量控制MAP的麻醉用药方法。Objective It is to compare the best dose effect relationship of remifentanil and propofol in the maintenanceof intravenous anesthesia for elderly , young and middle-aged and children , find out the difference of the dosage of remifen-tanil and propofol in the maintenance effect of general anesthesia among the 3 age groups , and provide reference for clinicalanesthesia. Methods The data of general anesthesia for elderly , middle-aged and young children ted according to the scientific research plan was reviewed. The group with the best results of the three age groups was deter-mined to be the elderly group （group L , 15 cases） , young and middle-aged group （ group Z , 30 ca se s ） , children group （group X , 20 cases ） . General anesthesia induction： the patients were injected with etomidate 0. 15 mg/kg and remifentanil 15 （ji/kg , and intravenous injection of atropine 0. 007 mg/kg and vecuronium 0. 12 mg/kg in group L ; and with etomidate0. 3 mg/kg and remifentanil 15μg/kg , and intravenous injection of atropine 0. 007 mg/kg and vecuronium 0. 12 mg/kg in group Z ; with propofol 1.5 mg/kg and remifentanil 15 ig/kg , and intravenous injection of atropine 0. 008mg/kg and vecu-ronium 0. 12 mg/kg in group X. Maintenance of general anesthesia： the patients in the group L were received constant speed infusion of remifentanil 50 μg（kg · h ） , adjusting propofol dosage to maintain and maintain MAP in anesthesia （MAP） was 5% lower than basal MAP （0 to 10% ） ; the group Z and group X were propospeed. The amount of remifentanil adjusted to maintain MAP in anesthesia was 5% lower than that in its basal MAP. All the patients were stopped reducing blood press five minites before the end of the surgery- Results The average maintenance efect of general anesthesia reached grade I. There was no significant difference in maintaining MAP stathree groups （ all P 〉 0. 05 ） . The stable index of MAP maintained in the three groups was 36. 7

关 键 词：老年人 中青年人 儿童 瑞芬太尼用量 丙泊酚用量 量效关系 

分 类 号：R614.2[医药卫生—麻醉学]