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瑞芬太尼在全麻中对异氟醚最低肺泡有效浓度的影响

Affection on Effective Concentration in Lowest Alveoli of Remifentanil for Enflurane with General Anesthesia
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摘要 目的探讨全麻下不同血药浓度的瑞芬太尼对安氟醚MAC的影响。方法选择ASA-Ⅰ-Ⅱ级拟行全麻下开腹手术的患者70例,随机分为7组(分别用Ⅰ-Ⅶ组表示),每组10例(n=10),患者入室后,给予阿托品0.5mg静脉注射。校正气体浓度监测仪。常规监测心电图、血压、心率、外周血氧饱和度。用气体浓度监测仪监测呼气末安氟醚浓度及PETCO2。用脑电监护仪监测双频谱指数(BIS值)来测定各组的镇静水平及预测体动反应。利用,TCI-Ⅰ靶控输注泵输注瑞芬太尼,各组设定的靶控血药浓度分别是0.0、1.0、1.5、2.0、4.0、8.0、16.0 ng/mL,每组对应设定的呼气末安氟醚浓度分别是1.6%、1.0%、0.8%、0.6%、0.5%、0.3%、0.1%,同时经面罩吸入高浓度的安氟醚,靶控输注5 min后静脉推注异丙酚2.0 mg/kg,氯琥珀胆碱1.5mg/kg,气管插管。调节氧流量为1.0 L/min,迅速调整吸入浓度,使安氟醚呼气末浓度恒定在预设浓度,PETCO2控制在3.99-4.65 kpa(30-35 mmHg)之间,切皮前安氟醚呼气末浓度恒定时间至少在15 min。每剂量组中第1位患者吸入预设的安氟醚浓度。结果单纯吸入安氟醚组的MAC值为1.52%,与以前报道的安氟醚MAC值1.68%是相似的,瑞芬太尼血药浓度在4.0-8.0 ng/mL时,即能量大限度地降低安氟醚MAC,出现较明显的封顶效应。各组BIS值的变化:各组间基础BIS值和用药后BIS值均无明显差异(P>0.05),每组内用药前后BIS值均有显著性差异(P<0.01),切皮前均能达到较满意的镇静水平。在体动组和非体动组中,切皮即刻BIS值差异无显著性(P>0.05)。结论瑞芬太尼和其他阿片类药物一样,能显著降低安氟醚的MAC值,并有较明显的封顶效应。瑞芬太尼血药浓度测定值比靶浓度值偏低,两者具有良好的相关性。 Objective To discuss the affection of MAC of enflurane in varied concentration of remifentanil with general anesthesia. Methods 70 patients of ASA Ⅰ~Ⅱ with laparotomy were divided into 7 groups randomly and 10 eases per each. The ECG, Bp, HR, SaO2, PETCO2 and BIS were monitored for the analgesia and body motion. The remifentanil was injected with TCI- Ⅰ pump with varied concentration,The varied inhaled enflumne was designed and intubation to control the concentration of englurane. Results q"ne MAC value was similar with reported paper in single inhaled enflurane that the peak effect had appeared when lower enflurane MAC at 4 - 8 ng/ml of remifentanil. The BIS value had no difference between groups in basic, after medication and body motion. The BIS had significant difference intra-group between and after medication. Conclusion The remifentanil might decrease the MAC value obviously with peak effect so that the lower ratio value have relation ship in the aspect of the effect.
作者 孙启芳
出处 《黑龙江医学》 2007年第3期167-170,共4页 Heilongjiang Medical Journal
关键词 瑞芬太尼 最低肺泡有效浓度 靶控输注 Remifentanil Lowest alveoli effect concentration TCI- Ⅰ
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