舒芬太尼靶控输注诱导时脑电双频指数及血流动力学的变化(前瞻性随机对照研究)

On changes of bispectral index and hemodynamic responses during anesthesia induction with target-controlled infusion of sufentanil:A prospective randomized controlled trial

目的观察不同剂量舒芬太尼复合丙泊酚靶控输注全麻诱导时脑电双频指数及血流力学的变化,探讨适用于短小腹腔镜手术的舒芬太尼诱导剂量。方法60例ASAⅠ～Ⅱ级择期全麻下行腹腔镜手术,按靶控输注舒芬太尼的效应室浓度不同随机分为3组,即A组(0.4ng/ml),B组(0.6ng/ml)和C组(1.2ng/ml)组,每组20例。丙泊酚血浆靶浓度均为3μg/ml,与舒芬太尼同时靶控输注,直至气管插管后5min停止输注。记录麻醉诱导气管插管过程中不同时点的脑电双频指数(bispectral index,BIS)、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、丙泊酚和舒芬太尼用量、预计苏醒时间。结果气管插管后C组BIS值明显低于A组和B组(插管后5min BIS值C组为39.8±5.2,A组为45.0±6.2,B组为43.7±6.0;qC-A=8.114,P=0.007;qC-B=4.687,P=0.037)。A组插管后3min MAP(79.8±9.3)mm Hg显著高于插管前即刻(72.1±7.9)mm Hg(q=8.042,P=0.007),HR(80±11)次/min亦显著高于插管前即刻(72±11)次/min(q=5.138,P=0.029)。B组仅在插管后1min MAP(84.7±8.7)mm Hg显著高于插管前即刻(71.2±6.3)mm Hg(q=31.546,P=0.000),B组插管后1min HR(81±10)次/min亦显著高于插管前即刻(71±10)次/min(q=16.433,P=0.000)。C组仅插管后1min MAP(79.5±9.8)mm Hg显著高于插管前(71.1±6.6)mm Hg(q=9.480,P=0.004),HR各时点无显著变化(P>0.05)。丙泊酚用量各组相似,舒芬太尼总量C组(73.9±13.6)μg显著高于A组(24.3±4.9)μg和B组(35.4±8.1)μg(qC-A=237.924,P=0.000;qC-B=119.385,P=0.000)。预计苏醒时间A组16min和B组28min短于C组54min。结论与丙泊酚复合靶控输注用于全麻诱导时,舒芬太尼呈剂量依赖性地降低BIS并抑制血流力学反应。舒芬太尼效应室靶浓度0.6ng/ml复合丙泊酚血浆靶浓度3μg/ml靶控输注适用于短小腹腔镜手术的全麻诱导。

Objective To investigate changes of bispectral index and hemodynamic responses during anesthesia induction with target-controlled infusion （TCI） of sufentanil at various doses combined with propofol, and to determine the appropriate dose of sufentanil during anesthesia induction for short-time laparoscopic operation. Methods Sixty patients with ASA physical status Ⅰ-Ⅱ scheduled for laparoscopic operation under general anesthesia were studied. Anesthesia was induced with sufentanil and propofol, both of which were given by TCI simultaneously until 5 min after tracheal intubation. The patients were randomized to receive sufentanil at a target effect-site concentration of 0.4 ng/ml （Group A）, 0.6 ng/ml （Group B）, or 1.2 ng/ml （Group C）, with 20 patients in each group. The propofol was maintained at a target plasma concentration of 3μg/ml. The bispectral index （BIS） , mean arterial pressure （MAP）, heart rate （HR）, total doses of propofol and sufentanil, and expected time of recovering consciousness were recorded at different times during anesthesia induction and tracheal intubation. Results The BIS values were significantly lower in the Group C than in the Group A or B after tracheal intubation （ at the time of 5 min after tracheal intubation, the BIS values were 39. 8 ±5.2 in the Group C, 45.0 ± 6.2 in the Group A, and 43.7 ± 6.0 in the Group B, respectively; q c-A = 8. 114,P = 0. 007; q c-B = 4. 687, P = 0. 037 ）. In the Group A, the MAP was at a significantly higher level at 3 min after intubation （79.8 ± 9.3 mmHg） than before intubation （72.1 ± 7.9 mm Hg） （q = 8. 042, P = 0. 007） , and the HR was also markedly increased at 3 min after intubation （80 ± 11 beat/min） than before intubation （72 ± 11 beat/rain） （ q = 5. 138, P = 0. 029）. In the Group B, the MAP at 1 min after intubation （84.7 ± 8.7 mmHg） was significantly higher than that before intubation （71.2 ± 6.3 mmHg） （ q = 31. 546, P =0. 000）, and the HR was also significantly higher at 1 min after intubation （81 ± 10 beat/min） than before intubation （71 ± 10 beat/min） （q = 16. 433, P = 0. 000）. In the Group C, only the MAP at 1 min after intubation （79.5 ± 9.8 mmHg） was significantly higher than that before intubation （71.1 ± 6.6 mm Hg） （ q = 9. 480, P = 0.004）, while no significant differences were recorded in HR at different times （P〉0.05）. A similar amount of propofol was used in each group. A significantly higher dose of sufentanil was administered in the Group C （73.9±13.6 μg） than in the Group A （24.3 ±4.9 μg） and the Group B （35.4 ±8.1μg） （q c-A= 237. 924, P = 0. 000; qc-B = 119. 385, P = 0. 000）. The expected time of recovering consciousness was shorter in the Group A and B than in the Group C. Conclusions Administered by target-controlled infusion with propofol, sufentanil dose-dependently reduces BIS and modifies hemodynamic responses during anesthesia induction. The target effect-site sufentanil concentration of 0.6 ng/ml combined with plasma propofol concentration of 3 μg/ml is suitable for anesthesia induction for short-time laparoscopic operation.