腹腔镜手术病人咪达唑仑-芬太尼-异丙酚麻醉诱导的优化配伍方案

The optimal dosage regimen of midazolam, propofol and fentanyl given in combination for induction of general anesthesia in patients undergoing laparoscopic operation

目的采用权重配方法探讨腹腔镜手术病人咪达唑仑、芬太尼、异丙酚复合麻醉诱导的优化配伍方案。方法选择ASAⅠ或Ⅱ级择期腹腔镜手术病人60例,男34例,女26例,年龄31-55岁。诱导药物的低效量和足量分别确定为咪达唑仑0.02、0.06mg/kg,芬太尼2、6μg/kg,异丙酚0.5、1.5 mg/kg。根据权重配方法,将病人随机分配至3种药物不同剂量组合的6个配伍组(n=10)。连续监测脑电双频谱指数(BIS)、心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)。各组依次静脉注射相应剂量咪达唑仑、芬太尼、异丙酚和罗库溴铵0.6 mg／kg行麻醉诱导和气管插管。记录诱导前即刻、异丙酚注入后1、2min、插管即刻、插管后1、3、5、7 min的BIS、MAP及HR。按权重配方法的剂量优化原则评判复合药效,分析各组份药的重要程度及相互作用的性质。结果以BIS为评价指标,当咪达唑仑0．06mg／kg、芬太尼5μg／kg、异丙酚1．0mg／kg配伍时,异丙酚为主药,异丙酚与咪达唑仑和芬太尼具有相加性作用;以MAP为评价指标,当咪达唑仑0．06 mg／kg、芬太尼5μg／kg、异丙酚1．5 mg／kg配伍时,异丙酚为主药,异丙酚与咪达唑仑具有协同性作用,异丙酚与芬太尼具有相加性作用;以HR为评价指标,当咪达唑仑0．06 mg／kg、芬太尼5μg／kg、异丙酚1．0 mg／kg配伍时,芬太尼为主药,异丙酚与咪达唑仑和芬太尼具有协同性作用。结论腹腔镜手术病人咪达唑仑、芬太尼、异丙酚复合麻醉诱导在维持镇静方面为相加作用,在维持血液动力学稳定方面为协同作用;优化配伍方案为咪达唑仑0.06mg/kg、芬太尼5μg/kg、异丙酚1.5mg/kg。

The optimal dosage regimen of midazolam, propefol and fentanyl was investigated when given in combination for induction of general anesthesia in patients undergoing laparoscopic operation. Sixty ASA Ⅰ or Ⅱ patients of both sexes （34 male, 26 female） aged 18-60 yrs scheduled for laparoscopic operation were included in this study. The patients were premedicated intramuscular scopolamine 0.3 mg. MAP, HR, SpO2 and BIS were monitored before and during anesthesia. Anesthesia was induced with midazolam （injected i.v. over 15 seconds） first, then fentanyl （over 15 s. ） followed by propefol （over 30 s. ）. Tracheal intubation was facilitated with rocuronium 0.6 mg· kg^-1. Each drug was distributed into 6 doses from maximal to minimal effective dose. The maximal and minimal dose of midazolam were 0.06 and 0.02 mg · kg^-1 , of fentanyl 6 and 2 μg·kg^-1 and of propefol 1.5 and 0.5 mg · kg^-1 respectively. Six dosage regimens were established according to weighted modification methods. BIS, MAP and HR were recorded immediately before induction （To , baseline）, 1 and 2 min after propefol administration （T1 ,T2） at laryngoscopy （T3） and 1, 3, 5 and 7 min after intubation （T4-7） . The effect and importance of each drug were evaluated based on the changes in BIS, MAP and HR. The optimal combination of the 3 drugs for induction of anesthesia is midazolam 0.06 mg·kg^-1 , fentanyl 5 μg·kg^-1 andpropofol 1.5 mg·kg^-1 in patients undergoing laparoscopic operation.