老年人瑞芬太尼、丙泊酚全麻维持中瑞芬太尼与丙泊酚的量效关系  

Relationship of the dosage of remifentanil and propofol used in the maintain stage of general anesthesia in elderly selective surgery

作　　者：刘焕结[1] 刘华[1] 罗芬 吕东森[1] 袁承城[1] 康力[1] LIU Huanjie;LIU Hua;LUO Fen;LYU Dongsen;YUAN Chengcheng;KANG Li(Bao’an Chinese Medicine Hospital,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13期1376-1380,1411,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2012年科研立项资助项目(2012053)

摘　　要：目的探讨老年人瑞芬太尼、丙泊酚静脉复合全麻维持中不同瑞芬太尼、丙泊酚配伍剂量与全麻维持效果的关系。方法选择老年择期手术患者120例,均实施气管插管全麻,全麻诱导方法均相同。全麻维持分为恒速泵注不同剂量丙泊酚、调节瑞芬太尼用量控制并维持全麻中MAP比基础MAP降低5%左右(0~10%)部分(简称BR法)和恒速泵注不同剂量瑞芬太尼、调节丙泊酚用量控制并维持全麻中MAP比基础MAP降低5%左右部分(简称RB法)。BR法共30例,随机分为丙泊酚泵速1.0 mg/(kg·h)组(B_(1.0)组)、1.5 mg/(kg·h)组(B_(1.5)组)、2.0 mg/(kg·h)组(B_(2.0)组)、2.5 mg/(kg·h)组(B_(2.5)组)、3.0 mg/(kg·h)组(B_(3.0)组),每组6例。瑞芬太尼起始泵速均为30μg/(kg·h),如瑞芬太尼用量增加到60μg/(kg·h),MAP降低未达预设范围,丙泊酚用量增加0.5 mg/(kg·h),再调节瑞芬太尼用量,如此反复直至降压达到预设范围;如瑞芬太尼用量降到零,MAP仍低于预设范围,降低丙泊酚用量0.5 mg/(kg·h),再调节瑞芬太尼用量,如此反复直至降压达到预设范围。RB法共90例,随机分为瑞芬太尼泵速60μg/(kg·h)组(R_(60)组)、55μg/(kg·h)组(R_(55)组)、50μg/(kg·h)组(R_(50)组)、45μg/(kg·h)组(R_(45)组)、40μg/(kg·h)组(R40组)、30μg/(kg·h)组(R_(30)组),每组15例。丙泊酚起始泵速均为2 mg/(kg·h),调节丙泊酚用量在25 min内控制并维持全麻中MAP比基础MAP降低5%左右。全部11组控制性降压均在手术结束前5 min停止。结果 (1)BR法中B_(1.0)组有3例,B_(1.5)组、B_(2.0)组、B_(2.5)组各有2例能够按原计划丙泊酚用量完成全麻维持;有18例需增加或减少丙泊酚用量后再调节瑞芬太尼用量完成全麻维持,这其中还有3例丙泊酚用量大于3.0 mg/(kg·h)才能完成全麻维持;还有3例按照原计划丙泊酚用量用药,但需在输入多巴胺的同时输入瑞芬太尼完成全麻维持。(2)RB法各组均可较容易地把全麻维持中的MAP控�Objective It is to investigate the relation of the dosage of remifentanil and propofol used in the maintain stage of general anesthesia in elderly selective surgery.Methods 120 old elderly undergoing selective surgery were selected.The methods of the general anesthesia induction were the same.The methods of the general anesthesia maintenance were BR and RB for short.The method BR was injecting different dosage of propofol at constant speed and adjusting the dosage of remifentanil to maintain the MAP about 5%lower than the basal MAP.The method RB was injecting different dosage of remifentanil at constant speed and adjusting the dosage of propofol to maintain the MAP about 5%lower than the basal MAP.The patients of the method BR were 30.According to the different dosage of propofol at constant speed,the 30 patients were divided into 5 groups randomly(n=6).The injection speeds of propofolare 1.0 mg/(kg·h)(group B 1.0),1.5 mg/(kg·h)(group B 1.5),2.0 mg/(kg·h)(group B 2.0),2.5 mg/(kg·h)(group B 2.5)and 3.0 mg/(kg·h)(group B 3.0).The initial dose of remifentanil was 30μg/(kg·h).If the dosages of remifentanil increase to 60μg/(kg·h),and the MAP could not reach the range of controlled hypotension,the dosage of propofol would increase 0.5 mg/(kg·h),then the dosage of remifentanil was adjusted again and again until the the MAP could reach the range of controlled hypotension.If the dosages of remifentanil reduce to 0μg/(kg·h),and the MAP was under the range of controlled hypotension,the dosage of propofol would reduce 0.5 mg/(kg·h),then the dosage of remifentanil was adjusted again and again until the MAP could reach the range of controlled hypertension.The patients of the method RB were 90.According to the different dosage of remifentanil at constant speed,the 90 patients were divided into 6 groups randomly(n=15).The injection speeds of remifentanil were 60μg/(kg·h)(group R 60),55μg/(kg·h)(group R 55),50μg/(kg·h)(group R 50),45μg/(kg·h)(group R 45),40μg/(kg·h)(group R 40)and 30μg/(kg·h)(group R 30)

关 键 词：择期手术的老年人 瑞芬太尼 丙泊酚 全麻维持 量效关系 

分 类 号：R971.2[医药卫生—药品]