不同剂量芬太尼对气管插管患者应激反应与脑电双频指数的影响

Effects of Different Doses of Fentanyl by Target-controlled Infusion on Stress Responese and BIS of Intubation under the Same Depth of Sedation during Anesthesia Induction

目的在应用脑电双频指数（BIS）监测镇静深度的条件下观察靶控输注（TCI）不同剂量芬太尼对插管应激反应及BIS的影响，探讨BIS在45±3的镇静深度下气管插管芬太尼TCI的有效血浆目标浓度。方法90例全麻下行手术患者，随机分为Ⅰ-Ⅲ组，每组30例，麻醉诱导：咪唑安定0．1mg·kg^-1，丙泊酚TCI根据BIS变化调整目标浓度至BIS值稳定在45±3，罗库溴铵0．8mg·kg^-1，Ⅰ～Ⅲ组芬太尼TCI血浆浓度分别设定为2．5，3．0，3．5ng·mL^-1。分别记录诱导前、诱导后2min、插管后1，3，5min血压、心率和BIS值，并于诱导前、插管后1，3，5min时点取血检测血浆去甲肾上腺素（NE）和血浆皮质醇（Cort）浓度。结果Ⅰ组患者插管后血浆NE浓度及血浆Cort浓度以及血压（SBP、DBP）和心率（HR）显著升高（P〈0．01），Ⅱ、Ⅲ两组患者的血浆NE浓度和血浆Cort浓度插管后虽升高但均在正常值范围内，与插管前比较差异无显著性（P〉0．05）；与诱导后2min比较，Ⅰ、Ⅱ组插管后1min BIS值均升高（P〈0．05），Ⅲ组BIS变化差异无显著性（P〉0．05）。结论在BIS值达到45±3的镇静深度下，芬太尼TCI血浆目标浓度达到3．0ng·mL^-1可有效预防气管插管应激反应，在血浆目标浓度达到3．5ng·mL^-1则可抑制插管引起的BIS升高且循环稳定。

Objective To investigate the effects of different doses of fentanyl given by target-controled infusion （TCI） on stress responses and BIS of intubation during general anesthesia induction when BIS was controlled at 45 ± 3 and to evaluate the effective TCI plasma concentration of fentanyl. Methods Ninety ASA Ⅰ - Ⅱ patients （49 males,41 females）, aged 24-55 years,weighing 48-75 kg, scheduled for elective abdominal surgery under general anesthesia were randomly divided into three groups 30 patients in each group . Patients group Ⅰ to Ⅲ received fentanyl by TCI with the target of hematoplasma concentration set at 2.5 ng·mL^-1 （ Ⅰ）, 3.0 ng·mL^-1 （Ⅱ）, 3.5 ng·mL^-1 （Ⅲ ） during induction. Before fentanyl administration, each patient received midazolam （0.1 mg· kg^-1 ） and propofol by TCI. Each patient received BIS moniter and the propofol TCI dose was adjusted by BIS until it has reached to 45 ±3 ,the dose of emserol was 0.8 mg·kg^-1, BP（SBP,DBP,MAP） ,HR and BIS were recorded before induction of anesthesia（ baseline）, and 1,3 and 5 min after tracheal intubation with blood samples obtained for determination of plasma norepinephrine （NE）and cortisol concentrations. Results The plasma NE and cortisol concentrations and BP,HR in group Ⅰ were significantly increased at the monment of and after tracheal intubation （P 〈 0.01 ）. The plasma NE and eortisol concentrations of Ⅱ and Ⅲ were increased after tracheal intubation but still in nomal range （P 〉 0. 05）. As compared with 2 min after induction BIS of group Ⅰ and Ⅱ after traehed intubation were significant increased （ P 〈 0.05）. There was no signifieaut change in BIS of group Ⅲ （ P 〉 0.05 ）. Conclusion When BIS reached to 45 - 3, The target plasma concentration of fentanyl above 3.0 ng·mL^-1 may attenuate the stress responses to tracheal intubation and fentanyl TCI concentration at 3.5 ng·mL^-1 can inhibit the BIS rise caused by tracheal intubation with stable hemodynamies.