老年患者靶控输注瑞芬太尼和丙泊酚的临床评价

Target-controlled infusions of remifentanil and propofol in elderly patients

目的:探讨老年患者靶控输注(target-controlled infusion,TCI)不同血浆浓度瑞芬太尼和丙泊酚的临床安全性和可行性,并评价Marsh参数应用于老年人丙泊酚TCI系统的性能。方法:30例老年患者,随机分为三组,每组10例。A组,丙泊酚复合硬膜外组;B组,丙泊酚复合瑞芬太尼(血浆浓度4μg/L)组;C组,丙泊酚复合瑞芬太尼(血浆浓度7μg/L)组。3组病例丙泊酚TCI的血浆浓度均为3mg/L。观察患者麻醉及术中的脑电双频指数(bispetralindex,BIS)、心率、血压、心率变异性等指标,并抽取桡动脉血,检测丙泊酚的血浆浓度。结果:(1)B,C组(血浆浓度4,7μg/L)的瑞芬太尼能有效抑制插管反应,但C组(血浆浓度7μg/L)麻醉诱导时低血压和窦缓的几率增加;(2)3组患者术中均能维持足够的麻醉深度(BIS值=45～60);(3)瑞芬太尼联合丙泊酚TCI不影响老年患者的苏醒;(4)Marsh参数的丙泊酚TCI系统用于我国老年患者偏离性(MDPE)为11.17%、精确度(MDAPE)为12.16%。结论:血浆浓度4,7μg/L的瑞芬太尼联合丙泊酚麻醉均能安全应用于老年患者的临床麻醉,但应用血浆浓度7μg/L的瑞芬太尼在麻醉诱导时应注意加强监测。采用Marsh参数的丙泊酚TCI系统可安全有效地应用于我国老年患者。

Objective： To investigate the clinical reliability and feasibility of target-controlled infusion （TCI） with different plasm concentration remifentanil and propofol. Methods： Thirty ASA Ⅰ-Ⅱ patients, ≥65 years old, undergoing selective lower abdominal operation were divided into 3 groups, group A with anesthesia using propofol combined with epidural block, group B with anesthesia using propofol and remifentanil （plasm concentration 4μg/L）, group C with anesthesia using propofol and remifentanil （plasm concentration 7 μg/L）. BIS value, heart rate, blood pressure, heart rate variability and so on, were recorded during anesthesia and operation. Radial arterial blood samples for analysis of plasma concentration of propofol were taken during operation. Results： （ 1 ） The intubation response of groups B and C was lower than that of group A . （2） The depth of anesthesia was enough during operation （ BIS value =45 -60）. （3） TCI propofol combined with remifentanil didn＇t lengthen the awaking time of patients; （4） MDPE of target-controlled infusion using propofol with Marsh parameters was 11.17% , MDAPE was 12.16% in Chinese elderly patients. Conclusion： Remifentanil with plasma concentration of 4 and 7 μg/L combined with propofol could be safely used during clinical anesthesia of old patient, but monitoring must be strengthened during induction when plasma concentration of remifentanil was 7 μg/L. TCI propofol with Marsh parameters could be applied to Chinese elderly patients safely and efficently.