瑞芬太尼50μg/(kg·h)与瑞芬太尼靶控血浆浓度20 ng/mL全麻维持效果比较  

Comparison of the general anesthesia maintenance effect between remifentanil 50 μg/( kg·h) and remifentanil target control plasma concentration of 20 ng/mL

作　　者：罗芬 陆建华[2] 刘华[3] 陈丽[3] 王珊 周骞[3] 康力[3] 刘焕结[3] LUO Fen;LU Jianhua;LIU Hua;CHEN Li;WANG Shan;ZHOU Qian;KANG Li;LIU Huanjie(Guangzhou Medical University,Guangzhou 511436,Guangdong,China;Guangzhou General Hospital of Guangdong Military Command of PLA,Guangzhou 510010,Guangdong,China;Bao’an chinese medicine Hospital,ShenZhen city,Guangdong 518133,China)

机构地区：[1]广州医科大学,广东广州511436 [2]广州军区广州总医院,广东广州510010 [3]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10期1038-1042,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市宝安区科技创新局2017年度科研基金项目(2014111)

摘　　要：目的观察在中青年择期手术患者全麻中固定瑞芬太尼靶控血浆浓度20ng/mL调节丙泊酚靶控血浆浓度控制并维持全麻中MAP方法和恒速泵注瑞芬太尼50μg/(kg·h)调节丙泊酚泵速控制并维持全麻中MAP方法的全麻维持效果是否相同。方法选择择期手术接受全麻的中青年患者65例,依瑞芬太尼全麻维持用药方式不同分为靶控给药组35例和恒速给药组30例,靶控给药组固定瑞芬太尼靶控血浆浓度20 ng/mL调节丙泊酚靶控血浆浓度控制并维持全麻中MAP比基础MAP降低5%左右(0~10%)。恒速给药组恒速泵注瑞芬太尼50μg/(kg·h)调节丙泊酚泵速控制并维持全麻中MAP比基础MAP降低5%左右(0~10%)。2组均在手术结束前5 min停用丙泊酚,手术结束时停用瑞芬太尼。结果靶控给药组瑞芬太尼靶控血浆浓度20 ng/mL全麻维持实际恒速泵注剂量为(48.48±6.28)μg/(kg·h),接近恒速给药组的50μg/(kg·h),2组维持MAP均达到预设的降压范围;2组间维持MAP平稳指数、维持MAP平稳指数比基础MAP平稳指数降低百分率、瑞芬太尼维持用量、丙泊酚维持用量、睁眼时间比较差异均无统计学意义(P均>0.05);2组全麻维持中不用肌肉松弛药均无体动发生,清醒拔管过程中均无躁动发生,且均无术中知晓,全麻维持效果均为Ⅰ级。结论全麻维持使用固定瑞芬太尼靶控血浆浓度20 ng/mL调节丙泊酚靶控血浆浓度控制并维持全麻中MAP比基础MAP降低5%左右的方法与恒速泵注瑞芬太尼50μg/(kg·h)调节丙泊酚用量控制并维持相同MAP范围方法的全麻维持效果相同,均达到全麻维持效果评级Ⅰ级。Objective It is to observe whether the general anesthesia maintenance effect of the fixed plasma target concentration of 20 ng/mL remifentanil for adjusting the propofol infusion rate to maintain MAP was the same as constant speed infusion of remifentanil 50μg/(kg·h)in the young and middle-aged patients undergoing selective surgery.Methods Sixty-five young and middle-aged patients undergoing selective surgery were randomly divided into target controlled infusion(TCI)group(n=35)and constant speed infusion(CSI)group(n=30)according to infusion method of remifentanil.The fixed plasma target concentration of 20 ng/mL remifentanil was used for adjusting the propofol infusion rate to maintain MAP about 5%(1%-10%)lower than the baseline in TCI group,constant speed infusion of remifentanil 50μg/(kg·h)was used for adjusting the control of propofol pump to maintain MAP about 5%(1%-10%)lower than the baseline in CSI group.Both groups were discontinued propofol 5 minutes before the end of surgery and remiftanil was discontinued at the end of the procedure.Results The actual constant speed pump injection rate of plasma target concentration of 20 ng/mL remifentanil for anesthesia maintenance was(48.48±6.28)μg/(kg·h)in TCI group,which was close to 50μg/(kg·h)of CSI group.Both groups achieved presumed set-down level of MAP.There was no significant difference between the two groups in maintaning MAP stationary index,remifentanil dosage,propofol dosage and time of openning eyes(P>0.05).No muscle relaxant medicine was used without body movement during anesthesia maintenance in both groups,there was no restlessness and intraoperation knowledge in both groups,the general anesthesia maintenance were evaluated as I level.Conclusion The general anesthesia maintenance effect of the fixed plasma target concentration of 20 ng/mL remifentanil for adjusting the propofol infusion rate to maintain MAP about 5%lower than the baseline was the same as constant speed infusion of remifentanil 50μg/(kg·d),both general anesthesia maintenanc

关 键 词：靶控给药 恒速给药 瑞芬太尼 血浆浓度 全麻维持效果 

分 类 号：R614.2[医药卫生—麻醉学]