不同剂量瑞芬太尼对全麻患者丙泊酚靶控输注诱导时麻醉深度的影响  

Effects of different dosages of remifentanil on anesthetic depth with propofol target controlled infusion in general anesthesia patients

作　　者：徐晖[1] 陆松虹[1] 张景俊[1] 潘松[1] 程亮[1] 吴鸿浩[1] XU Hui;LU Song-hong;ZHANG Jing-jun;PAN Song;CHENG Liang;WU Hong-hao(Department of Anesthesiology,the Third People＇s Hospital of Bengbu,Bengbu ANHUI 233000,Chin)

机构地区：[1]蚌埠市第三人民医院麻醉科,安徽蚌埠233000

出　　处：《中国新药与临床杂志》2018年第7期423-428,共6页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的研究不同剂量瑞芬太尼对丙泊酚靶控输注诱导时麻醉深度的影响。方法拟行全麻下腹腔镜手术的患者60例,ASAⅠ~Ⅱ级,随机分为四组,每组15例。丙泊酚靶控输注诱导的初始浓度设为1.5 mg·L-1,每4 min增加0.5 mg·L^(-1)。当患者意识消失后,Ⅰ组静脉输注氯化钠注射液,Ⅱ、Ⅲ、Ⅳ组分别输注瑞芬太尼0.1、0.2、0.4μg·kg-1·min-1,在改良警觉镇静评分表(MOAA/S)评分为0分时给予阿曲库铵0.6 mg·kg^(-1),3 min后行气管插管,每分钟记录一次熵指数、丙泊酚效应室浓度和MOAA/S评分。结果与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ组反应熵(RE)和状态熵(SE)值均降低(P<0.05或P<0.01),Ⅱ、Ⅲ、Ⅳ组之间无显著差异(P>0.05)。各组的MOAA/S评分均随着丙泊酚输注时间的延长及其预测效应室浓度的增加而不断降低,Ⅰ组和Ⅱ组之间无显著差异(P>0.05),Ⅲ组、Ⅳ组与Ⅰ组相比均有显著差异(P<0.01)。结论瑞芬太尼0.2~0.4μg·kg-1·min-1能够加深丙泊酚靶控输注麻醉诱导时的镇静深度。AIM To investigate the effects of different dosages of remifentanil on anesthetic depth in propofol target controlled infusion（ TCI） induction. METHODS Sixty patients, classified as ASA Ⅰ-Ⅱ,undergoing laparoscopic surgery under general anesthesia were randomly divided into four groups. Anesthesia was induced with propofol TCI. The target plasma concentration of propofol was started with 1.5 mg·L-1 and increased 0.5 mg·L^（-1） every four minutes.The patients received remifentanil infusion when they lose response,and the dosage was set at 0.1, 0.2 and 0.4 μg·kg-1·min-1 in the group Ⅱ, group Ⅲ and group Ⅳ,respectively. The patients received sodium chloride injection in the group Ⅰ as control. When modified observer＇s assessment of alertness/sedation（ MOAA/S） score was zero, atracrium 0.6 mg·kg-1 was given and then facilitated tracheal intubation after 3 minutes. The effect site concentration of propofol, the values of response entropy（RE） and state entropy（SE）, and MOAA/S score were recorded. RESULTS The values of RE and SE in the group Ⅰ were higher than those in the group Ⅱ, group Ⅲ and group Ⅳ（P〈0.05 or P〈0.01）. And there were no significant differences among group Ⅱ, group Ⅲ and group Ⅳ（ P〈0.05）. The MOAA/S score of each group was decreased with the increasing effect site concentration and duration of propofol TCI. There was no significant different between group Ⅰ and group Ⅱ（ P〈0.05）, but with significant differences for group Ⅲ and group Ⅳ compared with group Ⅰ（P〈0.01）. CONCLUSION Remifentanil 0.2-0.4 μg·kg-1·min-1 can increase the sedative effect of propofol TCI.

关 键 词：瑞芬太尼 丙泊酚 麻醉 全身 靶控输注 麻醉深度 

分 类 号：R971[医药卫生—药品]