不同剂量地佐辛对腹腔镜气腹时七氟烷MACBAR的影响  

Effect of Dezocine with Different Doses on Sevoflurane MACBAR During Laparoscopic Pneumoperitoneum

作　　者：杨加辉 杨小霖[2] 王琼 徐娟[2] 王丹[2] Yang Jiahui;Yang Xiaolin;Wang Qiong(Department of Anesthesiology,North Sichuan Medical College,Nanchong,Sichuan 637000;Department of Anesthesiology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院麻醉学系,四川南充637000 [2]川北医学院附属医院麻醉科,四川南充637000

出　　处：《四川医学》2020年第12期1245-1249,共5页Sichuan Medical Journal

基　　金：南充市市校科技战略合作项目(编号:18SXHZ0161、19SXHZ0151)。

摘　　要：目的比较不同剂量地佐辛对腹腔镜气腹刺激时七氟烷抑制患者肾上腺素能反应的最低肺泡有效浓度的影响。方法纳入腹腔镜择期手术患者100例,随机分为四组(D0,D1,D2,D3)各25例。麻醉诱导前,D0组静脉推注10ml生理盐水,D1~D3组分别静推含0.1、0.2及0.3 mg/kg地佐辛的生理盐水稀释液10 ml。麻醉诱导时,四组患者均静脉推注丙泊酚2~4 mg/kg及瑞芬太尼1μg/kg,待意识消失后静注罗库溴铵0.6 mg/kg完成气管插管。调节七氟烷吸入浓度分别使四组患者呼末七氟烷浓度迅速达到其预设值,维持稳定20 min后开始建立气腹,观察并记录气腹刺激前后血压及心率变化,采用序贯法测定七氟烷MACBAR,并测定气腹刺激前后血浆肾上腺素及去甲肾上腺素浓度。结果 D0组七氟烷MACBAR(4.78±0.19)%明显高于D1组(3.85±0.16)%、D2组(3.60±0.15)%和D3组(3.59±0.14)%,差异有统计学意义(P<0.05),但D2组和D3组差异无统计学意义(P>0.05)。四组患者气腹刺激前后血浆肾上腺素及去甲肾上腺素浓度变化,差异无统计学意义(P>0.05)。结论地佐辛可显著降低七氟烷的MACBAR,但当单次静脉注射剂量大于0.2 mg/kg时,对七氟烷MACBAR降低的影响甚微,且同等程度应激反应被抑制时不同剂量地佐辛并不会对血中肾上腺素及去甲肾上腺素的变化水平产生影响。Objective To compare effects of dezocine with different doses on minimum alveolar concentration(MAC)of sevoflurane that inhibits adrenergic response during laparoscopic pneumoperitoneum stimulation.Methods 100 patients undergoing elective laparoscopic surgery were enrolled and randomly divided into four groups(D0,D1,D2,D3)with 25 cases in each group.Before anesthesia induction,D0 group was injected with 10 ml normal saline,while D1~D3 groups were injected with 0.1,0.2 and 0.3 mg/kg dezocine diluted by 10 ml normal saline,respectively.During anesthesia induction,four groups were given 2~4 mg/kg propofol and 1μg/kg remifentanil.After consciousness disappeared,0.6 mg/kg rocuronium was injected and tracheal intubation was completed.The concentration of sevoflurane inhalation was adjusted so that end-tidal sevoflurane concentration of four groups quickly reached its preset value and maintained stability for 20 minutes before establishing pneumoperitoneum.Changes in blood pressure and heart rate before and after pneumoperitoneum stimulation were observed and recorded.Sequential methods were used to determine sevoflurane MACBAR.Concentrations of plasma adrenaline and norepinephrine before and after pneumoperitoneum stimulation were determined.Results Sevoflurane MACBAR of D0 group(4.78±0.19)%was higher than that in D1 group(3.85±0.16)%,D2 group(3.60±0.15)%and D3 group(3.59±0.14)%with statistically significant difference(P<0.05).There was no difference between D2 and D3 group(P>0.05).There was no significant difference in plasma adrenaline and norepinephrine concentrations before and after pneumoperitoneum stimulation in four groups(P>0.05).Conclusion Dezocine could significantly reduce sevoflurane MACBAR.When a single intravenous injection dose is greater than 0.2 mg/kg,it would have little effect on reducing sevoflurane MACBAR.And when stress responses with same degree were suppressed,dezocine with different doses will not affect blood adrenaline and norepinephrine.

关 键 词：七氟烷 地佐辛 最低肺泡有效浓度 肾上腺素能反应 腹腔镜 

分 类 号：R614.2[医药卫生—麻醉学]