靶控输注异丙酚复合瑞芬太尼或舒芬太尼喉罩麻醉的效果研究

Target controlled infusion of Propofol with Remifentanil or Sufentanil for anesthesia with laryngeal mask airway ventilation

目的比较靶控输注瑞芬太尼或舒芬太尼对异丙酚喉罩麻醉作用的影响。方法60例择期手术患者,分别采用异丙酚(P组,n=20)、异丙酚瑞芬太尼(PR组,n=20)、异丙酚舒芬太尼(PS组,n=20)静脉靶控输注。瑞芬太尼麻醉诱导时靶浓度为4 ng/ml,术中维持靶浓度调节范围为2～6 ng/ml,舒芬太尼诱导时靶浓度为0.5 ng/ml,术中维持靶浓度调节范围为0.2～1 ng/ml,预期手术结束前30 min靶浓度设定为0.2 ng/ml,异丙酚初始靶浓度为2μg/ml,逐渐增加靶浓度值直至意识消失。术中调整异丙酚、瑞芬太尼、舒芬太尼靶浓度维持麻醉深度。观察喉罩置入前后血流动力学、以及麻醉药用量、麻醉后恢复情况。结果三组患者诱导后收缩压(SP)、舒张压(DP)明显降低(P值<0.05),PR组心率明显减慢(P值<0.05),PR、PS组喉罩置入前后SP、DP无明显改变,P组则明显升高(P值<0.05)。PR组、PS组异丙酚麻醉维持用量分别较P组降低32.7%、35.5%(P值<0.05)。PS组睁眼时患者自主呼吸的ET-CO2值明显高于P组和PR组(P值<0.05),停药至患者自主呼吸ET-CO2降至45mmHg以下的时间也明显长于P组和PR组(P值<0.05)。结论瑞芬太尼、舒芬太尼均能明显减少全静脉喉罩麻醉时异丙酚用量,抑制喉罩置入的反应,但舒芬太尼会延迟麻醉苏醒期喉罩拔除时间。

Objective To evaluate the influence of Remifentanil and Sufentanil on effect of Propofol anesthesia with laryngeal mask airway ventilation.Methods Sixty patients scheduled for elective surgery were randomly divided into propofol group（group P,n=20）,propofol with remifentanil group（group PR,n=20） and propofol with sufentanil group（group PS,n=20）.The patients were anesthetized with target controlled infusion of Propofol and Remifentanil（4 ng/ml） or Sufentanil（0.5 ng/ml）.The initial target plasma concentration of Propofol was 2 μg/ml,and increased step by step until loss of consciousness.The hemodynamic changes and the dosage of Propofol and recovery of anesthesia were observed in all patients.Results Blood pressure was significantly lower in all groups,and HR decreased in PR group after induction of anesthesia（P 〈0.05）.Systolic and diastolic blood pressure increased significantly after laryngeal mask airway insertion in group P.The dosage of Propofol required for maintenance of anesthesia in group PR and group PS were reduced by 32.7% and 35.5% respectively.ET-CO2 by spontaneously breathing was higher in the PS group than in group P and group PR when the patients opened their eyes.The times from drug withdrawal to ET-CO2 drop to 45mmHg by spontaneously breathing were longer in the PS group than in group P and group PR.Conclusions Remifentanil and sufentanil can reduce significantly the dosage of propofol for anesthesia with laryngeal mask airway ventilation,inhibit the hemodynamic responses to laryngeal mask airway insertion.But the times of laryngeal mask airway extubation could be prolonged by sufentanil during the revitalization of anesthesia.