舒芬太尼与丙泊酚靶控输注在老年肠道肿瘤根治术麻醉中配伍方案优化的观察性研究  

An observational study on optimization of combination regimen of target controlled infusion of sufentanil and propofol in anesthesia for elderly patients undergoing radical resection of intestinal tumors

作　　者：刘淑媛 杜海亮 高伟 曹丽萍 LIU Shu-yuan;DU Hai-liang;GAO Wei;CAO Li-ping(Department of Anesthesia Surgery,the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine,Xi'an 710000,China;Department of Anesthesia,Xi'an Chest Hospital,Xi'an 710100,China)

机构地区：[1]西安交通大学医学院第一附属医院麻醉手术部,西安710000 [2]西安市胸科医院麻醉科,西安710100

出　　处：《临床药物治疗杂志》2023年第10期62-68,共7页Clinical Medication Journal

摘　　要：目的应用响应曲面分析舒芬太尼与丙泊酚在行肠道肿瘤根治术的老年患者麻醉中的相互作用,并探究靶控输注舒芬太尼与丙泊酚的最佳配伍剂量。方法选取2020年1月至2023年1月西安交通大学医学院第一附属医院接受肠道肿瘤根治术并行静脉全身麻醉诱导的老年患者作为研究对象,选择舒芬太尼与丙泊酚靶控输注起始配伍浓度,观察患者麻醉后的警觉/镇静评分(OAA/S)≤1分的意识消失时间(T_(LOC)),依据手术过程中脑电双频指数(BIS)、平均动脉压(MAP)和心率(HR)调整舒芬太尼和丙泊酚的靶控输注浓度,维持BIS 40~60、MAP≥60 mm Hg(1 mm Hg=0.133 kPa)、HR>50次。记录舒芬太尼和丙泊酚输注后至OAA/S评分≥3分的意识恢复时间(T_(ROC))。应用响应曲面模型分析舒芬太尼与丙泊酚在肠道肿瘤根治术麻醉诱导中的药效学相互作用,并计算最佳配伍浓度范围。结果共纳入200例患者,每组10例,共20组。响应曲面模型显示,舒芬太尼与丙泊酚在行肠道肿瘤根治术老年患者麻醉诱导过程中的体动反应和循环反应具有显著协同作用,其最佳配伍浓度范围:靶控输注丙泊酚浓度为2.00μg/mL时,使用舒芬太尼0.40~0.70μg/kg;靶控输注丙泊酚浓度为3.00μg/mL时,使用舒芬太尼0.20~0.38μg/kg;靶控输注丙泊酚浓度为4.00μg/mL时,使用舒芬太尼0.19~0.22μg/kg;靶控输注丙泊酚浓度为4.70μg/mL时,使用舒芬太尼0.20μg/kg。结论舒芬太尼与丙泊酚镇静药效呈协同作用,通过不同的药效反应确定了舒芬太尼与丙泊酚最佳配伍剂量范围,在最佳配伍浓度范围内可以为患者提供良好的麻醉效果,并且具有较快的麻醉诱导和麻醉恢复速度。Objective To investigate the interaction between sufentanil and propofol during anesthesia in elderly patients undergoing intestinal tumor radical surgery by response surface analysis,and to explore the optimal dosage of target controlled infusion of sufentanil and propofol.Methods The elderly patients who underwent radical resection of intestinal tumors and induction of intravenous general anesthesia in the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine from January 2020 to January 2023 were selected as the study subjects,and the initial compatibility concentration of sufentanil and propofol target controlled infusion was selected to observe the time to loss of consciousness(T_(LOC))with a score of≤1 in the ob⁃server's assessment of alertness/sedation scale(OAA/S)after anesthesia.The target controlled infusion concentrations of sufent⁃anil and propofol were adjusted according to bispectral index(BIS),mean arterial pressure(MAP)and heart rate(HR)during the operation to maintain BIS at 40 to 60,MAP≥60 mm Hg(1 mm Hg=0.133 kPa),HR>50 times.The time to recovery of consciousness(T_(ROC))from the infusion of sufentanil and propofol to an OAA/S score of≥3 was recorded.A response surface model was applied to analyze the pharmacodynamic interaction between sufentanil and propofol in anesthesia induction of in⁃testinal tumor radical surgery,and the optimal concentration range for compatibility was calculated.Results Response surface model showed that sufentanil and propofol had significant synergistic effects on the body and circulatory responses during the induction of anesthesia in elderly patients undergoing radical resection of intestinal tumors,and the optimal concentration ranges for compatibility were as follows:sufentanil of 0.40 to 0.70μg/kg with propofol of 2.00μg/mL,sufentanil of 0.20 to 0.38μg/kg with propofol of 3.00μg/mL,sufentanil of 0.19 to 0.22μg/kg with propofol of 4.00μg/mL,sufentanil of 0.20μg/kg with propofol of 4.70μg/mL.Conclusion The sedative effect of

关 键 词：舒芬太尼 丙泊酚 肠道肿瘤根治术 响应曲面模型 相互作用 最佳配伍剂量 

分 类 号：R971.2[医药卫生—药品]