静脉输注腺苷对胆道手术中异丙酚用量及术后芬太尼镇痛效果的影响

Effects of adenosine on propofol consumption and postoperative analgesic efficacy of fentanyl in patients with biliary tract surfery

目的观察胆道手术中持续静脉输注腺苷对术中异丙酚用量及术后芬太尼镇痛效果的影响。方法45例择期全麻下行胆道手术的病人，ASAⅠ或Ⅱ级，年龄22岁-65岁，随机分为腺苷1组（A1组）、腺苷2组（A2组）和生理盐水组（NS组）。于全麻诱导后10min开始分别持续静脉输注腺苷35、70μg·kg^-1·min^-1和生理盐水至术毕。术中持续输注芬太尼2μg·kg^-1·h^-1、阿曲库铵0．6mg·kg^-1·h^-1，并根据脑电双频指数（bispectral index，BIS）、平均动脉压（MAP）和心率（HR）调整异丙酚的用量，维持BIS值40～50。术毕采用患者自控静注芬太尼镇痛。记录：①麻醉前（T0）、切皮即刻（T1）、切皮后15min（T2）、切皮后30min（T3）及术毕（T4）时的MAP和HR；②术中异丙酚平均用量；③术后30min、2、4、24、48h的视觉模拟评分（VAS），记录术后芬太尼用量和是否额外追加其他止痛药及用量。结果在T0、T1时点，三组间MAP和HR无统计学差异（P〉0．05），在T2、T3、T4时点，A2组MAP和HR低于A1组和NS组（P〈0．05）；A2组异丙酚平均用量少于A1组和NS组（P〈0．05）；术后VAS评分及芬太尼用量3组间无统计学差异（P〉0．05）。结论胆道术中持续静脉输注腺苷70μg·kg^-1·min。能减少术中异丙酚用量，但不影响术后VAS评分及芬术尼用量。

Objective To observe the effects of intraoperative continuous intravenous infusion of adenosine on propofol consumption and postoperative analgesic efficacy of fentanyl in patients with biliary tract surgery. Methods Forty-five ASA class Ⅰ or Ⅱ patients scheduled for biliary tract surgery were randomized into 3 groups （n = 15）： group A1, group A2 and group NS. Ten minutes after the induction of general anesthesia, the patients received the continuous intravenous infusion of adenosine 35μg·kg^-1·min^-1, 70μg·kg^-1·min^-1 and normal saline, respectivetly, until the end of surgery. Fentanyl 2μg·kg^-1·h^-1 and atracurium 0.6 mg·kg^-1·h^-1 were continuously infused throughout the surgery. The propofol was titrated to maintain a BIS target level between 40-50 and a stable hemodynamics. Postoperative analgesia was provided by patient-controlled analgesia with fentanyl. The following values were observed： ① changes of mean arterial pressure（MAP） and heart rate（HR） before induction of aneathesia（T0）; 0（T1）, 15（T2） and 30（T3） minutes after incision, and at the end of surgery（T4）; ②propofol comsumption; ③visual analogue scale（VAS） at 30 min, and 2, 4, 24, 48 h after surgery. Results There was no significant difference in MAP and HR at To and T1 among each groups（P〉 0.05）. Compared with groups A1 and NS, MAP and HR decreased at T2, T3, and T4 in group A2 （P〈0.05）. The average propofol consumption was also lower in group A2 （P〈0.05）. There was no significant difference in VAS at all time points and in fentanyl consumption after surgery among each groups（P〉0.05）. Conclusion Continuous intravenous infusion of adenosine 70 μg·kg^-1·min could spare propofol consumption, but do not affect VAS and postoperative fentanyl dose.