摘要
目的调查丙泊酚联合瑞芬太尼靶控输注(TCI)全凭静脉麻醉非心脏手术患者术中知晓的发生情况,分析其发生的可能原因及相关因素,探讨预防TCI全凭静脉麻醉患者术中知晓的策略,降低术中知晓的发生率。方法随机选择TCI静脉全身麻醉患者1061例,年龄19-72岁,ASAI~Ⅲ级,均未予神经电生理监测。麻醉诱导TCI丙泊酚血浆靶浓度3.0~4.0μg/ml、瑞芬太尼血浆靶浓度5~6ng/ml、维库溴铵0.1mg/kg或顺苯磺酸阿曲库铵0.2mg/kg,麻醉维持TCI丙泊酚血浆靶浓度为3.O~3.5μg/ml、瑞芬太尼血浆靶浓度5~6ng/ml,预计手术时间大于2h。切皮前静脉注射芬太尼0.1mg,间断静脉注射维库溴铵或顺苯磺酸阿曲库铵。手术结束前15min停止输注丙泊酚,缝合皮肤前停止输注瑞芬太尼,并静脉注射芬太尼1μg/kg。记录患者丙泊酚和瑞芬太尼的输注总剂量及输注时间、维持期丙泊酚的血浆靶控浓度。术后第1天及第3天随访患者,调查全麻术中知晓的发生情况。结果丙泊酚输注总剂量为(973.48±471.56)mg,输注时间为(138.74±112.85)min,血浆靶控浓度为(3.15±0.38)μg/ml,输注速率为(9.41±3.59)mg·kg^-1·h^-1。瑞芬太尼输注总剂量为(1130.29±676.19)μg,输注时间(140.76±113.02)min,平均输注速率为(0.15±0.05)μg·kg^-1·min^-1。1061例患者中,均未发生术中知晓,术中做梦者14例,发生率为1.3%。结论术中瑞芬太尼血浆靶控浓度设定为5~6ng/ml的情况下,丙泊酚血浆靶控浓度维持在(3.15±0.38)μg/ml,即平均输注速率为(9.41±3.59)mg·kg^-1·h^-1,能提供合适的麻醉深度,术中知晓的发生率明显降低。
Objective To investigate the incidence of awareness during total intravenous anesthesia by target-controlled infusion (TCI) of propopol combined with remifentanil in non-cardiac surgery and to analyze the possible reasons for its occurrence and related factors, in order to reduce the incidence of intraoperative awareness during total intravenous anesthesia by TCI. Methods One thousand and sixty-one patients who underwent the selected non-cardiac surgery were enrolled, age ranged from 19 to 72 years, ASA I~Ⅲ, without neurophysiological monitoring. The plasma target concentrations of propofol and remifentanil were set according to the Marsh's model and Minto equation respectively. All patients received propofol and remifentanil at an initial plasma concentration of 3.0-4.0μg/ml and 5-6 ng/ml respectively, vecuronium 0. 1 mg/kg or cisatracurium besilate 0. 2 mg/kg was administered and then tracheal intubation was achieved. Anestheisa were maintained by TCI of propofol (plasma target concentration, 3.0-3.5 μg/ml) and remifentanil (plasma target concentration 5.0-6.0 ng/ml), fentanyl 0. 1 mg was given before skin incision if the surgery lasted more than 2 hours estimated, neuromuscular blocking drugs were adminstered intermittently during anesthesia. TCI of propofol was ceased at 15 minutes before surgery was over, while TCI of remifentanil was ceased at skin closure and fentanyl 0. 1 μg/kg was given. The consumption and transfusing duration of propofol and remifentanil, and the plasma concentrations of propofol during maintain period were recorded. Interviews were conducted twice during 24 h and 72 h postoperatively to investigate intraoperative awareness. Results The mean infusion dose of propofol was (973.48±471.56) mg and the mean infusion time was (138.74±12.85) min. The mean plasma concentration and infusion rate of propofol was (3.15±0. 38) /lg/ml and (9.41±3.59) mg· kg^-1·h^-1. The mean infusion dose of remifentanil was (1 130. 29±676.19)μg and the mean infusion time was (140. 76 ± 113.02) min. The mean infusion rate of reminfentmlil was (0. 15±0. 05) μg·kg^-1·min^-1. Of all the patients, nobody was reported awareness, 14 (1.3%) reported dreaming during anesthesia Conclusion The plasma concentration of remifentanil setting at 5.0-6.0 ng/ml, combined with the mean plasma concentration of (3. 15±0. 38) μg/ml or infusion rate of (9.41±3. 59) mg·kg^-1·h^-1 of propofol, can maintain adequate depth of anesthesia, significantly reducing the incidence of awareness.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第11期1073-1075,共3页
Journal of Clinical Anesthesiology
关键词
靶控输注
丙泊酚
瑞芬太尼
术中知晓
发生率
Targevcontrolled infusion
Propofol
Remifentanil
Intraoperative awareness
Incidence