靶控输注不同低效应室浓度舒芬太尼复合丙泊酚用于腹腔镜手术麻醉的效果  

Efficacy of target-controlled infusion of sufentanil at different target effect-site concentrations combined with propofol for anesthesia in laparoscopic surgery

作　　者：赵艳[1] 唐慧敏[2] Zhao Yan;Tang Huimin(Department of Anesthesiology and Perioperative Medicine,Shanghai Fourth People′s Hospital Affiliated to Tongji University,Shanghai 200081,China;Department of Anesthesiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]同济大学附属上海市第四人民医院麻醉与围术期医学科,200081 [2]北京大学第三医院麻醉科,100191

出　　处：《中华麻醉学杂志》2020年第7期830-833,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价靶控输注(TCI)不同低效应室浓度舒芬太尼复合丙泊酚用于腹腔镜手术麻醉的效果。方法择期全麻下腹腔镜手术患者60例,性别不限,BMI 17.0~29.5 kg/m2,ASA分级Ⅰ或Ⅱ级,年龄18~68岁。全麻诱导采用TCI舒芬太尼和丙泊酚。采用密闭信封法随机分为3组(n=20):效应室靶浓度0.08 ng/ml组(Ⅰ组)、0.10 ng/ml组(Ⅱ组)和0.12 ng/ml组(Ⅲ组)。麻醉维持:3组TCI舒芬太尼效应室浓度恒定(Ⅰ组、Ⅱ组和Ⅲ组分别为0.08、0.10和0.12 ng/ml),调节丙泊酚血浆靶浓度,术中维持BIS值40~60,维持MAP及HR波动幅度不超过基础值20%,根据手术需要间断静脉注射罗库溴铵,术毕时停止丙泊酚和舒芬太尼TCI。记录手术时间、TCI时间、舒芬太尼和丙泊酚用量、麻醉维持期使用麻黄碱、阿托品例数、术毕睁眼时间和气管拔管时间,记录恶心呕吐、肌肉僵直、寒战、躁动、呼吸抑制及术中知晓的发生情况,记录术后30 min内和术后30 min^24 h使用镇痛药例数。于气管拔管后20 min,每组随机取10例患者经桡动脉取血行血气分析和血糖检测。结果与Ⅰ组比较,Ⅲ组舒芬太尼用量增加,Ⅱ组和Ⅲ组睁眼时间和气管拔管时间延长(P<0.05);与Ⅱ组比较,Ⅲ组舒芬太尼用量增加(P<0.05)。3组余指标比较差异均无统计学意义(P>0.05)。结论复合丙泊酚腹腔镜手术麻醉时推荐TCI舒芬太尼效应室靶浓度0.08 ng/ml。Objective To evaluate the efficacy of target-controlled infusion(TCI)of sufentanil at different target effect-site concentrations combined with propofol for anesthesia in laparoscopic surgery.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of either gender,aged 18-68 yr,with body mass index of 17.0-29.5 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were included in this study.Anesthesia was induced with sufentanil combined with propofol given by TCI.The patients were divided into 3 groups(n=20 each)using the sealed envelope method:target effect-site concentration 0.08 ng/ml group(Ⅰgroup),0.10 ng/ml group(Ⅱgroup)and 0.12 ng/ml group(Ⅲgroup).Anesthesia was maintained as follows:the target effect-site concentrations of sufentanil given by TCI were 0.08,0.10,and 0.12 ng/ml inⅠ,Ⅱ,andⅢgroups,respectively,the target plasma concentration of propofol was adjusted,and the bispectral index value was maintained at 40-60,the fluctuation range of mean arterial pressure and heart rate was maintained not exceeding 20%of the baseline value,intermittent intravenous boluses of rocuronium was given when needed,and propofol and sufentanil TCI was stopped at the end of operation.The operation time,time for TCI,consumption of sufentanil and propofol,the number of cases used ephedrine and atropine during the period of anesthesia maintenance,time to eye opening at the end of operation and time of tracheal extubation,nausea and vomiting,muscle stiffness,shivering,agitation,respiratory depression and intraoperative awareness were recorded,and the number of cases used analgesics within 30 min and 30 min-24 h after operation was recorded.Results Compared with groupⅠ,the consumption of sufentanil was significantly increased in groupⅢ,and the time to eye opening and extubation time were prolonged inⅡandⅢgroups(P<0.05).The consumption of sufentanil was significantly higher in groupⅢthan in groupⅡ(P<0.05).There was no significant difference in the other para

关 键 词：药物释放系统 舒芬太尼 二异丙酚 腹腔镜 

分 类 号：R614[医药卫生—麻醉学]