咪唑安定、芬太尼、异丙酚联合诱导时对镇静催眠作用的影响

Effect of midazolam, fentanyl and propofol coinduction on hypnotic and sedation in gengerl anesthesia

目的：采用权重配方法分析咪唑安定(Mid)、芬太尼(Fen)和异丙酚(Pro)联合诱导时在镇静、催眠上相互作用的性质。方法：60例美国麻醉协会(ASA)分级Ⅰ-Ⅱ级的择期行腹腔镜手术的病人根据权重配方法设计，均匀分配至6个不同剂量水平不同的用药组(配伍组1～6)，麻醉诱导为依次注入Mid(15s)，Fen(15s)，Pro(30s)和罗库溴铵0．6mg·kg^(-1)。Pro注入后3min行气管插管。记录诱导前、异丙酚注入后1、2min、插管即刻、插管后1、3、5、7min的脑电双频谱指数(BIS)、平均动脉压(MAP)、心率(HR)值。结果：配伍组1的诱导期BIS变化值较为理想。结论：Mid、Fen和Pro在镇静催眠上呈相加作用，理想的诱导剂量为Mid 0．02 mg·kg^(-1)、Fen0．0025mg·kg^(-1)、Pro 0．8 nag·kg^(-1)。

AIM： To investigate hypnotic and sedation interaction between midazolam, fentanyl and propofol in coinduction in general anesthesia. METHODS： Sixty patients, ASA class Ⅰ or Ⅱ , scheduled for elective celoscope operation were evenly distributed to 6 different compound dose groups according to weighted modification method. Anesthesia was induced with midazolam which was administered over 15 s, and fentanyl which was administered over 15 s, and propofol which was administered over 30 s, then rocuronium 0.6 mg·kg^-1 was administered to facilitate tracheal intubation. BIS, MAP, HR were recorded at following and 2 min after induction, just times： before induction, 1 at intubation, 1 and 3 and 5 and 7 min after intubation. RESULTS： The important degree of every drug was as follow： propofol 〉 fentanyl 〉 midazolam. The optimal combinations was midazolam 0.02 mg·kg^-1, fentanyl 0. 0025 mg·kg^-1 and propofol 0.8 mg·kg^-1. The optimal ratio was 1.0 ： 0. 125 ： 40. The nature of interaction was additive. CONCLUSION： The midazolam, fentanyl and propofol combination possess addtitive interaction in sedation and hypnosis. The optimal combinations was midazolam 0.02 mg·kg^-1, fentanyl 0. 0025 mg·kg^-1 and propofol 0.8 mg·kg^-1.