不同浓度舒芬太尼联合丙泊酚靶控输注对麻醉深度的影响及相应EC_(50)和脑BIS_(50)的测定

Influence of different concentrations of sufentanil combined with propofol by target controlled infusion on anesthesia depth and measurement of EC_(50) and BIS_(50)

目的观察不同浓度舒芬太尼联合内泊酚靶控输注（TCI）对脑电双频谱指数（BIS）的影响，测定意识丧失及体动反应消失时相应丙泊酚将就室浓度（EC50）和BIS50的值。方法择期全麻手术女性45例（ASAⅠ～Ⅱ级），病例来自广州医学院附属市一人民医院，随机分为A、B、C3组，每组15例，分别以舒夯太尼0、0．12、0．24μg／L作持续靶控输注，6rain后3组皆以0．6mg／L启动丙泊酚靶控，并按0．3mg／L递增丙泊酚。记录BIS基础值、舒芬太尼达效应室浓度后的BIS值、丙泊酚递增后的BIS和警觉镇静评估法（OAA／S）评分及挤压三角肌反应；丙泊酚效应室浓度为0．9、1．5、2．1mg／L时，挤压三角肌后BIS的增加量；丙泊酚注射痛情况；测定意识丧失及体动反应消失时相应的EC50、EC95、BIS50、BIS95结果B、C组BIS值在舒芬太尼输注前后变化差异无统计学意义（P〉0．05）。意识丧失时A、B、C组的内泊酚EC50／EC95分别为1．9／2．4、1．6／2．1、1．4／1．9mg／L；BIS50／BIS95分别为64／55、69／61、72／59。体动反应消失时A、B、C组的丙泊酚EC50／EC95分别为3．0／3．7、1．4／2．0、0．9／1．4mg／L；BIS50／BIS95分别为49／40、74／62、84／75。丙泊酚EC为0．9、1．5、2．1mg／L时，三角肌挤压刺激的BIS增加量，A组与B、C组相比差异有统计学意义（P〈0．01）。丙泊酚注射痛发生率A组明显高于C组（P〈0．05）：结论舒芬太尼0．12μg／L、0．24μg／L靶控不会引起BIS值显著变化，而与丙泊酚联合使用时可降低意识丧失、体动反应消失时的丙泊酚EC50同时相应BIS50有所上升；且舒芬太尼可以明显降低刺激所导致的BIS增加量，减少丙泊酚注射痛现象。

Objective To compare the change of BIS under the TCI of different concentrations of sufentanil combined with propofol and to measure the EC50 of propofol, BIS50 at the end-points of loss of consciousness and movement. Methods Forty-five female patients with ASA Ⅰ or Ⅱ , were scheduled to undergo elective operation by general anesthesia. All patients were randomly allocated into three groups of 15 patients each, namely group A,B,C. In group A, no sufentanil was given. In group B and C, EC of 0. 12μg/L and 0.24 μg/L sufentanil were given respectively. Propofol was started with target concentration of 0. 6 mg/L in all groups after calculated sufentanil effect-site concentrations was reached, and was increased 0.3 mg/L step by step until observation was over. Following parameters were recorded or calculated ： （ 1 ） the basic values of BIS, and the BIS after sufentanil target concentrations were reached ; （2） BIS, OAA/S and response to painful triangular muscle squeeze were recorded in order; （3） the absolute difference during the eourse of painful triangular muscle squeeze at propofol concentrations as 0.9,1.5,2. 1 mg/L; （4） the pain scale on the site of propofol injection; （5） EC50 ,EC95 ,BIS50 ,BIS50 at different clinieal end-points. Results There are no significant differences in group B and C between the BIS before and after sufentanil infusion （ P 〉 0.05 ）. At the clinical end-point of loss of consciousness,the propofol EC50/EC95 of group A .B ,C was 1.9/2.4, 1.6/2.1, 1.4/1.9 mg/L respectively;the BISso/BIS95 was 64/55, 69/61, 72/59. At the clinical end-point of loss of response to movement,the propofol EC50/EC95 of group A, B, C was 3.0/3.7, 1.4/2. 0, 0.9/1.4 mg/L respectively; the BIS50/BIS95 was 49/40, 74/62 as 84/75. At three different points of propofol EC such as 0.9, 1.5 and 2. 1 mg/L, the increment of BIS（ABIS） with that in group B and C in group A was significantly different （ P 〈 0.01 ）. The pain scales on the site of propofol injection were significantly different between group A and C. （ P 〈 0.05 ）. Conclusions 0. 12 and 0.24 μg/L sufentanil can not affect BIS obviously. However, sufentanil combined with propofol can cause loss of consciousness and movement in the fashion of a lower propofol EC50 and a higher BIS50. Sufentanil can significantly suppress the increment of BIS after noxious stimulus,and reduce pain scales on the site of propofol injection.