丙泊酚复合雷米芬太尼行颅脑手术麻醉的血药浓度

Blood concentration of propofol combined and remifentanil during general anesthesia for intracranial operation

目的 探讨丙泊酚复合雷米芬太尼行颅脑手术时两药合适的血浆药物浓度.方法 60例择期颅内肿瘤手术患者,随机分为P4组（n=30）和P6组（n=30）,所有患者均采用雷米芬太尼18 μg·kg^-1·h^-1泊酚12 mg·kg^-1·h^-1恒速泵注麻醉诱导,根据需要补充丙泊酚0.5～1 mg/kg保持脑电双频指数（BIS）低于60.P4组采用丙泊酚4 mg·kg^-1·h^-1,P6组采用6 mg·kg^-1·h^-1;复合雷米芬太尼10 μg·kg^-1·h^-1麻醉.术中根据BIS的变化增加或减少丙泊酚的输入量,维持BIS在40～60.记录不同时点的BP、HR、BIS,记录各组丙泊酚的累积用量和血管活性药物的使用情况,测定血浆丙泊酚浓度.结果 两组麻醉诱导平稳,无插管反应发生.麻醉中P4组BIS（49.70±2.75）显著高于P6组（45.80±3.82）;P4组和P6组丙泊酚麻醉维持平均剂量分别为（4.43±0.42）和（5.77±0.38）mg·kg^-1·h^-1.P4组和P6组血丙泊酚浓度分别为（2.00±0.35）和（2.58±0.45）μg/ml.结论 丙泊酚复合10μg·kg^-1·h^-1芬太尼全凭静脉麻醉行颅脑手术,合适的血浆靶控浓度宜为（2.32±0.55）μg/ml.

Objective To explore the suitable plasma level of propofol and remifentanil during general anesthesia in patients undergoing intracranial operation. Methods Sixty patients operation were randomly allocated to P4 group （n=30） and P6 group （n=30）. The anesthesia was carried out with vecuronium 0.1 mg/kg, remifentanil 18 μg·kg^-1·h^-1d propofol 12 mg·kg^-1·h^-1 A supplemental dose of propofol 0. 5-1 mg/kg was injected to keep BIS less than 60. Anesthesia was maintained with remifentani110μg · kg ^-1 ·h^-1 andpropofol4mg·kg^-1·h^-1 inP4 group or6mg·kg^-1·h^-1 in P6 group. The BP, HR and BIS were recorded. The blood samples were taken for determining plasma level of propofol with high performance liquid chromatography. Results The anesthesia induction was smooth and there was no intubation reaction. The BIS of P4 group（49.70±2. 75） was significantly higher than that of P6 group（45.80± 3.82）. The average propofol doses for maintaining anesthesia were（4.43±0. 42） mg·kg^-1·h^-1 in P4 group and （5.77±0.38）mg·kg^-1·h^-1 in P6 group,respectively. The plasma concentrations of propofol of P4 and P6 group were（2.00 ±0.35） μg/ml and （2.58 ± 0.45） μg/ml, respectively. Conclusion The suitable plasma level of propofol,combining with remifentanil 10/μg · kg ^-1 ·h^-1 for the anesthesia of intracranial operations, was （2.32±0.55） μgg/ml.