靶控输注瑞芬太尼对胸手术患者血液动力学的影响

Effects of Target-controlled Infusion of Remifentanil on Hemodynamics in Patients Undergoing Thoracic Surgery

目的:观察瑞芬太尼不同血浆靶浓度对胸手术患者血液动力学的影响,探讨瑞芬太尼对循环系统的影响机制。方法:将40例择期胸手术患者,随机分为R6组、R8组(均n=20),瑞芬太尼血浆靶浓度分别为6、8μg/L;记录患者食管超声探头放置成功后安静平卧时(T0)、靶控输注瑞芬太尼开始后5min(T1)、7min(T2)、10min(T3)时平均动脉压(MAP)、心输出量(CO)、每搏输出量(SV)、心率(HR)、体循环血管阻力(TSVR)、血流加速度(ACC)、血流峰速度(PV)、左室射血时间(LVET)和脑电双频指数(BIS)值。结果:R6组HR略有下降,CO、SV、ACC、PV、TSVR、LVET无明显改变;R8组血浆靶浓度的瑞芬太尼引起MAP、CO、HR和TSVR明显降低,SV增加,LVET明显延长,PV、ACC无明显改变。靶控输注瑞芬太尼10min内患者意识状态无改变;6μg/L比8μg/L血浆靶浓度瑞芬太尼对血液动力学影响较小。结论:血浆靶浓度8μg/L的瑞芬太尼引起明显血液动力学波动;瑞芬太尼减慢心率和扩张血管可能是其影响血液动力学改变的主要机制。

Objective- To observe the effects of different target plasma concentrations of remifentanil on hemodynamics in patients undergoing thoracic surgery, and discuss the mechanism of remifentanil on circulation. Methods： Patients （ASA Ⅰ or Ⅱ ） aged 40-60 years and weighed 52-74 kg undergoing pulmonary lobectomy or segmentectomy were randomly divided into 2 groups （n= 20 for each group）,group R6 （6μg/L）and group R8 （8 μg/L）according to target plasma concentration of remifentanil. Radial artery was cannulated and mean arterial pressure （MAP） was continuously monitored. At the same time electro cardio graph （ECG）,pulse blood 02 saturation （SpO2） and the bispectral index （BIS） were monitored as well. After target-controlled infusions （TCI） of remifentanil 5 min （T1）,7 min （T2） and 10 min（T3）,the HemosonicTM 100 transesophageal echodoppler probe was placed through nose into esophagus for monitoring mean arterial blood pressure （MAP）, cardiac output （ CO ）, stroke volume （ SV ）, heart rate （ HR ）, peak acceleration （ ACC ）, peak velocity （PV） and left ventricular ejection time index （LVET）. Results： There was a decrease in HR in group R6 compared to that in group R8. No obvious changes in levels of CO, SV, ACC, PV, TSVR and LVET were found in two groups. The values of MAP, CO, HR and TSVR were significant lower in group R8 compared to those of group R6. The values of SV and LVET were increased in group R8 compared to those of group R6. There were no significant differences in PV and ACC between the two groups. There was no change in relation to level of consciousness in 10 min of TCI of remifentanil. The effect of TCI of remifentanil on hemodynamics was lower in 6 μg/L than that of 8 μg/L. Conclusion： The hemodynamics was significantly changed at 8 μg/L of TCI of remifentanil. The results suggest that lower HR and decreased blood vessel resistance may be the reasons of effect of remifentanil on hemodynamics.