雷米芬太尼对丙泊酚靶控输注诱导期间效应室浓度及麻醉深度的影响

张景俊; 徐晖; 程亮; 潘松; 吴鸿浩

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

雷米芬太尼对丙泊酚靶控输注诱导期间效应室浓度及麻醉深度的影响

张景俊 , 徐晖 , 程亮 , 潘松 , 吴鸿浩

文章导航 > 蚌埠医学院学报 > 2014, 39 > 12: (1671-1673)

引用本文:

Citation:

雷米芬太尼对丙泊酚靶控输注诱导期间效应室浓度及麻醉深度的影响

安徽省蚌埠市第三人民医院麻醉科, 233000

作者简介: 张景俊(1976-), 男, 主治医师.

通讯作者: 徐晖, 副主任医师.bbxuhui@hotmail.com ;

中图分类号: R614.2

Effect of remifentanil on the effect compartment concentration and anesthesia depth during propofol target-controlled infusion period

Department of Anesthesiology, The Third People's Hospital of Bengbu, Bengbu Anhui 23300, China

Corresponding author: XU Hui, 副主任医师.bbxuhui@hotmail.com ;

CLC number: R614.2

摘要: 目的: 观察丙泊酚靶控输注(TCI)诱导期间泵注雷米芬太尼对丙泊酚效应室浓度(EC)、熵指数和心血管反应的影响.方法: 将择期手术患者22例,随机均分为观察组和对照组.2组均以血浆血药浓度为靶目标进行TCI,丙泊酚靶控血药初始浓度设为1.5 μg/ml,每4 min增加0.5 μg/ml,当改良警觉/镇静评分(MOAA/S)为1分时,对照组和观察组分别静脉泵入0.9%氯化钠注射液和雷米芬太尼0.2 μg·kg^-1·min^-1,当MOAA/S为0分时给予肌松药3 min后行气管插管.观察记录丙泊酚EC、熵指数[反应熵(RE)、状态熵(SE)]、平均动脉压(MAP)和心率(HR),于诱导前(T₀)、气管插管前3 min即给肌松药时(T₁)、插管即刻(T₂)、插管后1 min(T₃).结果: 观察组T₁～T₃丙泊酚EC均低于对照组(P< 0.05～P< 0.01).2组T₁～T₃ RE和SE差异均无统计学意义(P >0.05).观察组T₃ MAP和T₁～T₃ HR均明显低于对照组(P< 0.01).结论: 丙泊酚TCI诱导期间泵入雷米芬太尼使麻醉深度不变的情况下丙泊酚用量明显减少,血压和HR被抑制更明显.
- 雷米芬太尼 /
- 丙泊酚 /
- 靶控输注 /
- 熵指数 /
- 效应室浓度
Abstract: Objective: To investigate the effect of remifentanil on the effect compartment concentration(EC),response entropy(RE),state entropy(SE) and hemodynamical response during propofol target-controlled infusion(TCI) general anesthesia period.Methods: Twenty-two ASA classⅠ-Ⅱ patients undergoing elective surgery were randomly divided into the experimental group and control group,eleven cases in each group.In the two groups,the plasma concentration was as the target objective to do TCI.The initial plasma concentration was set to 1.5 μg /ml,increased by 0.5 μg /ml every 4 minutes until the Modified Observer Assessment of Alertness and Sedation(MOAA/S) score=1.The patients in experimental group were received with remifentanil infusion at 0.2 μg·kg^-1·min^-1,while the patients in control group were received with normal saline at 0.2 μg·kg^-1·min^-1.Tracheal intubation was operated after 3 minutes with muscular relaxants when MOAA/S was equal to 0.Propofol EC,RE,SE,mean arterial pressure(MAP) and heart rate(HR) were recorded when anesthesia was inducted with propofol TCI,including before anesthesia(T₀),at the time of infusion with muscle relaxants(T1),at the time of intubation(T₂) and at 1 min after intubation(T₃).Results: Propofol EC in experimental group was lower than that in control group at T₁-T₃(P< 0.05 to P< 0.01).There was no significant difference of RE and SE at T₁-T₃ between the two groups(P >0.05).MAP at T₃ and HR at T₁-T₃ in experimental group were lower than those in control group(P< 0.01).Conclusions: The doseage of propofol was decreased obviously during induction of general anesthesia by infusing remifentanil and propofol.At same time,HR and BP were inhibited obviously,but no changes of RE and SE.
- remifentanil /
- propofol /
- target-controlled infusion /
- entropy /
- effect compartment concentration

[1]	于布为,彭章龙.赵永泉.高龄病人异丙酚分步TCI时效应室浓度及BIS的变化[J].中华麻醉学杂志,2002,22(12):711-714.
[2]	Ellarkmatm HK,Laenaenn VM,Alves TM,et al.Spectral entropy and bispectral index as measures of the electroencephalographic effect of sevoflurane[J].Anesthesiology,2004,101(6):1275-1282.
[3]	Davis PJ,Finkel JC,Orr RJ,et al.A randomized,double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients[J].Anesth Analg,2000,90(7):863-871.
[4]	Elliott P,O'Hare R,Bill KM,et al.Severe cardiovascular depression with remifentanil[J].Analg,2000,91(4):58-61.
[5]	Mertens MJ,Olofsen E,Engber FH,et al.Propofol reduces perioperative remifentnil requirements in a synergistic manner:response surface modeling of perioperative remifentanil propofol interactions[J].Anesthesiology,2003,99(5):347-359.
[6]	Koitabashi T,Johansen JW,Sebel PS,et al.Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia[J].Anesth Analg,2002,94:1530-1533.
[7]	O'Hare RA,Mirakhur RK,Reid JE,et al.Recovery from profol anaesthesis supplemented with remifentanil[J].Br J Anaesth,2001,86(6):361-365.
[8]	阮绪广,詹鸿,全小会.熵在全身麻醉深度监测中的应用[J].临床麻醉学杂志,2007,23(2):121-122.
[9]	Vanluchene AL,Struys MM,Heyse BE,et al.Spectral entropy measurement of patient responsiveness during propofol and remifentanil.A comparison with the bispectral index[J].Br J Anaesth,2004,93(5):645-654.

[1]	梁启胜 , 杨茗竣 , 符炜 , 凌云志 . 脑电双频指数指导下丙泊酚、舒芬太尼联合靶控对冠状动脉旁路移植术麻醉诱导期血流动力学影响. 蚌埠医学院学报, 2012, 36(10): 1155-1158.
[2]	郭全周 . 地佐辛与芬太尼联合靶控输注丙泊酚用于无痛ERCP的对比研究. 蚌埠医学院学报, 2014, 39(11): 1538-1539.
[3]	陆松虹 , 徐晖 , 潘松 , 张景俊 , 李勇 . 不同剂量瑞芬太尼对全麻患者丙泊酚靶控输注诱导剂量及时间的影响. 蚌埠医学院学报, 2012, 36(3): 277-279.
[4]	陈龙 , 张茂银 , 耿兴云 . 丙泊酚靶控复合吸入低浓度异氟烷在小儿短小手术中的应用. 蚌埠医学院学报, 2007, 32(6): 720-722.
[5]	彭晓东 , 吴庆玲 , 郑立东 , 李家宽 . Narcotrend分级指导下丙泊酚靶控输注用于高血压患者麻醉的临床观察. 蚌埠医学院学报, 2015, 40(4): 467-469. doi: 10.13898/j.cnki.issn.1000-2200.2015.04.016
[6]	陆松虹 , 王忠云 . 雷米芬太尼和芬太尼分别联合丙泊酚诱导麻醉对气管插管患者血流动力学的影响. 蚌埠医学院学报, 2007, 32(2): 166-167.
[7]	李雪蓉 , 吴金 , 陈启 , 邱媛媛 . 熵指数在ICU机械通气患者镇静监控中的应用. 蚌埠医学院学报, 2016, 41(9): 1245-1246. doi: 10.13898/j.cnki.issn.1000-2200.2016.09.041
[8]	李克寒 , 杨惠敏 , 郭丹 . 瑞芬太尼或不同剂量地佐辛全麻诱导期喉罩置入对丙泊酚半数有效血浆靶浓度的影响. 蚌埠医学院学报, 2016, 41(10): 1299-1301,1305. doi: 10.13898/j.cnki.issn.1000-2200.2016.10.013
[9]	李晓立 , 李晓红 , 文公堂 , 王南海 , 金钟 . 靶控输注丙泊酚与联合瑞芬太尼用于无痛人工流产术的临床效果比较. 蚌埠医学院学报, 2008, 33(4): 405-408.
[10]	吴宣 , 沈勤 , 肖建军 . 靶控输注瑞芬太尼对全麻苏醒期心血管反应的影响. 蚌埠医学院学报, 2015, 40(4): 464-466. doi: 10.13898/j.cnki.issn.1000-2200.2015.04.015
[11]	李华忠 , 徐继海 , 宋际明 , 袁管京 , 黄忠义 . 丙泊酚与瑞芬太尼靶控输注对腹腔镜胆囊切除术的麻醉效果及病人术后认识功能的作用. 蚌埠医学院学报, 2018, 43(7): 904-906,911. doi: 10.13898/j.cnki.issn.1000-2200.2018.07.017
[12]	吴年生 , 汪东学 , 王玲 . 右美托咪定联合瑞芬太尼和丙泊酚泵注对甲状腺术中神经电生理监测的影响. 蚌埠医学院学报, 2020, 45(2): 207-210. doi: 10.13898/j.cnki.issn.1000-2200.2020.02.019
[13]	葛春林 . 硬膜外麻醉下丙泊酚靶控输注镇静在老年患者中的应用. 蚌埠医学院学报, 2007, 32(3): 303-305.
[14]	赵琛 , 李应杰 . 瑞芬太尼复合丙泊酚在无痛胃镜检查中的应用. 蚌埠医学院学报, 2014, 39(8): 1080-1081.
[15]	陈仁军 , 胡春涛 , 袁力勇 , 刘功俭 . 静脉预注硫酸镁抑制丙泊酚注射痛的临床研究. 蚌埠医学院学报, 2012, 36(1): 29-32.
[16]	邵兰 . 丙泊酚和芬太尼不同配伍剂量用于人工流产术麻醉效果比较. 蚌埠医学院学报, 2005, 30(1): 59-60.
[17]	张庆文 , 马明 . 丙泊酚配伍芬太尼、氧化亚氮用于人工流产术麻醉的对比观察. 蚌埠医学院学报, 2005, 30(4): 311-313.
[18]	张静 , 詹春光 , 陈永亮 . 瑞芬太尼联合丙泊酚用于控制性降压对胃黏膜内pH值的影响. 蚌埠医学院学报, 2008, 33(5): 548-551.
[19]	邱庆荣 . 咪达唑仑联合芬太尼、丙泊酚用于人工流产术的麻醉处理. 蚌埠医学院学报, 2010, 35(10): 1027-1029.
[20]	张桥 . 丙泊酚复合瑞芬太尼静脉麻醉用于支撑喉镜下声带息肉切除术. 蚌埠医学院学报, 2013, 37(4): 449-450,454.

点击查看大图

计量

文章访问数: 3472
HTML全文浏览量: 283
PDF下载量: 7
被引次数: 0

雷米芬太尼对丙泊酚靶控输注诱导期间效应室浓度及麻醉深度的影响

通讯作者: 徐晖, 副主任医师.bbxuhui@hotmail.com;

作者简介: 张景俊(1976-), 男, 主治医师.

安徽省蚌埠市第三人民医院麻醉科, 233000

收稿日期: 2013-11-07

关键词:

摘要: 目的: 观察丙泊酚靶控输注(TCI)诱导期间泵注雷米芬太尼对丙泊酚效应室浓度(EC)、熵指数和心血管反应的影响.方法: 将择期手术患者22例,随机均分为观察组和对照组.2组均以血浆血药浓度为靶目标进行TCI,丙泊酚靶控血药初始浓度设为1.5 μg/ml,每4 min增加0.5 μg/ml,当改良警觉/镇静评分(MOAA/S)为1分时,对照组和观察组分别静脉泵入0.9%氯化钠注射液和雷米芬太尼0.2 μg·kg^-1·min^-1,当MOAA/S为0分时给予肌松药3 min后行气管插管.观察记录丙泊酚EC、熵指数[反应熵(RE)、状态熵(SE)]、平均动脉压(MAP)和心率(HR),于诱导前(T₀)、气管插管前3 min即给肌松药时(T₁)、插管即刻(T₂)、插管后1 min(T₃).结果: 观察组T₁～T₃丙泊酚EC均低于对照组(P< 0.05～P< 0.01).2组T₁～T₃ RE和SE差异均无统计学意义(P >0.05).观察组T₃ MAP和T₁～T₃ HR均明显低于对照组(P< 0.01).结论: 丙泊酚TCI诱导期间泵入雷米芬太尼使麻醉深度不变的情况下丙泊酚用量明显减少,血压和HR被抑制更明显.

English Abstract

Effect of remifentanil on the effect compartment concentration and anesthesia depth during propofol target-controlled infusion period

Corresponding author: XU Hui, 副主任医师.bbxuhui@hotmail.com

Department of Anesthesiology, The Third People's Hospital of Bengbu, Bengbu Anhui 23300, China

Received Date: 2013-11-07

Abstract: Objective: To investigate the effect of remifentanil on the effect compartment concentration(EC),response entropy(RE),state entropy(SE) and hemodynamical response during propofol target-controlled infusion(TCI) general anesthesia period.Methods: Twenty-two ASA classⅠ-Ⅱ patients undergoing elective surgery were randomly divided into the experimental group and control group,eleven cases in each group.In the two groups,the plasma concentration was as the target objective to do TCI.The initial plasma concentration was set to 1.5 μg /ml,increased by 0.5 μg /ml every 4 minutes until the Modified Observer Assessment of Alertness and Sedation(MOAA/S) score=1.The patients in experimental group were received with remifentanil infusion at 0.2 μg·kg^-1·min^-1,while the patients in control group were received with normal saline at 0.2 μg·kg^-1·min^-1.Tracheal intubation was operated after 3 minutes with muscular relaxants when MOAA/S was equal to 0.Propofol EC,RE,SE,mean arterial pressure(MAP) and heart rate(HR) were recorded when anesthesia was inducted with propofol TCI,including before anesthesia(T₀),at the time of infusion with muscle relaxants(T1),at the time of intubation(T₂) and at 1 min after intubation(T₃).Results: Propofol EC in experimental group was lower than that in control group at T₁-T₃(P< 0.05 to P< 0.01).There was no significant difference of RE and SE at T₁-T₃ between the two groups(P >0.05).MAP at T₃ and HR at T₁-T₃ in experimental group were lower than those in control group(P< 0.01).Conclusions: The doseage of propofol was decreased obviously during induction of general anesthesia by infusing remifentanil and propofol.At same time,HR and BP were inhibited obviously,but no changes of RE and SE.