布托啡诺对丙泊酚抑制宫腔镜手术体动Cp_(50)的影响  

Effect of butorphanol on propofol inhibiting CP_(50) of body movement in hysteroscopic surgery

作　　者：杨沁岩 石岚[1] 欧媛媛 黎国媛 黄立[1] YANG Qinyan;SHI Lan;OU Yuanyuan;LI Guoyuan;HUANG Li(Departrment of Anesthesiology,Chongqing Municipal Seventh People′s Hospital,Chongqing 400054,China)

机构地区：[1]重庆市第七人民医院麻醉科,400054

出　　处：《重庆医学》2021年第10期1725-1728,共4页Chongqing medicine

基　　金：重庆市科卫联合基金项目(2019QNXM009);重庆市巴南区科技计划基金项目(2019SHSY524)。

摘　　要：目的探讨等效镇痛剂量的布托啡诺或芬太尼对靶控输注丙泊酚用于宫腔镜手术无体动的半数有效血浆浓度(Cp_(50))的影响。方法选择2019年11月至2020年5月在该院拟行宫腔镜手术的患者46例,按照手术先后顺序采用随机数字表法分为布托菲诺组(B组)和芬太尼组(F组),B、F组患者分别于手术操作前5 min静脉缓慢注射等效镇痛剂量的酒石酸布托啡诺20μg/kg和芬太尼1μg/kg,均靶控输注丙泊酚麻醉,初始血浆靶浓度设为2.5μg/mL,采用序贯法确定下一患者的血浆靶浓度,用序贯法公式计算丙泊酚抑制宫腔镜手术患者体动的Cp50及其95%CI。观察患者入室后(T0)、麻醉后(T1)和刮除子宫内膜操作刺激最强时(T2)的生命体征变化,T1和T2时的脑电意识伤害指数,麻醉后患者不良反应发生情况。结果B、F组患者靶控输注丙泊酚的Cp_(50)及其95%CI分别为2.23(2.12~2.34)μg/mL和2.67(2.21~3.22)μg/mL,F组靶控输注丙泊酚的Cp_(50)明显高于B组(P<0.05);F组患者T1时SpO2明显低于B组(P<0.05),且F组呼吸抑制发生率和术后疼痛比例均高于B组(P<0.05)。结论合用布托啡诺时靶控输注丙泊酚的有效血浆浓度明显低于芬太尼,且不良反应少,布托啡诺用于宫腔镜手术更安全有效。Objective To investigate the effect of equivalent analgesic dose of butorphanol or fentanyl on the half-effective plasma concentration(Cp_(50))of target controlled infusion(TCI)propofol in the hysteroscopic surgery without body movement.Methods The patients undergoing hysteroscopic surgery were selected and randomly divided into the butorphanol group(group B)and fentanyl group(group F).The equivalent analgesic dose of butorphanol tartrate(20μg/kg)and fentanyl(1μg/kg)were intravenously and slowly injected in the group B and group F at preoperative 5 min respectively.The TCI propofol anesthesia was performed in both groups.The initial plasma targeted concentration(Cp)was set to 2.5μg/mL,Cp of the next patient was determined by the sequential method,the sequential formula was used to calculate Cp_(50) and its 95%CI for inhibiting the body movement of the patients undergoing hysteroscopic surgery.The changes of vital signs were observed at entering the operation room(T0),after anesthesia(T1),and strongest stimulation of operation(T2),the EEG awareness injury index were observed at T1 and T2,as well as the adverse reactions occurrence of the patients after anesthesia.Results The Cp_(50) and 95%CI of TCI propofol in the group B an F were 2.23(2.12-2.34)μg/mL and 2.67(2.21-3.22)μg/mL,respectively.Cp_(50) of TCI propofol in the group F was significantly higher than that in the group B(P<0.05);SpO2 at T1 in the group F was significantly lower than that in the group B(P<0.05),moreover the incidence rate of respiratory depression and postoperative pain ratio in the group F were significantly higher than those in the group B(P<0.05).Conclusion The effective plasma concentration of TCI propofol when combined with butorphanol is significantly lower than fentanyl,moreover has fewer adverse reactions,the butorphanol use in hysteroscopic surgery is more safe and effective.

关 键 词：丙泊酚 布托菲诺 芬太尼 宫腔镜手术 半数有效血浆靶浓度 

分 类 号：R614.2[医药卫生—麻醉学]