不同靶浓度舒芬太尼对腹部手术患者七氟醚MACBAR的影响

Effects of different target concentrations of sufentanil on MACBAR of sevoflurane in patients undergoing abdominal surgery

目的评价不同靶浓度舒芬太尼对七氟醚抑制50％腹部手术患者切皮诱发应激反应的最低肺泡有效浓度（MACBAR）的影响。方法择期拟行腹部手术患者80例，年龄20—60岁，体重指数〈30ks／0，ASAⅠ或Ⅱ级，随机分为4组（n=20），S0组：不使用舒芬太尼；S1-3组：舒芬太尼效应室靶浓度分别为0．12、0．18和0．24ng／ml。气管插管后吸入七氟醚，新鲜气流量10L／min。S0组气管插管后不给予舒芬太尼，其余组分别按设定目标靶浓度输注舒芬太尼。根据序贯法进行试验，S0-3组初始呼气末七氟醚浓度分别为3．0％、1．8％、1．3％和1．1％，根据患者对切皮的反应（切皮时MAP和HR中任何一项升高幅度≥切皮前的25％为阳性反应）以1．2倍等比级增减，计算七氟醚MACBAR。结果与S0组比较，S1组、S2组和S3组七氟醚MACBAR均降低（P〈0．05）；与S1组比较，S2组和S3组七氟醚MACBAR均降低（P〈0，05）；S3组与S2组MACBAR比较差异无统计学意义（P〉0．05）。结论舒芬太尼效应室靶浓度0．12、0．18和0．24ng／ml均可降低七氟醚MACBAR,增强七氟醚抑制应激反应的效应，且呈浓度依赖性。

Objective To investigate the effects of three different effect-site concentrations （Ce） of sufentanil given by TCI on the minimum alveolar concentration of sevoflurane for blunting adrenergic responses to skin incision （MACBAR） in patients undergoing abdominal surgery.Methods Eighty ASA I or II patients, aged 20-60 yr, body mass index 〈 30 kg/m^2 , undergoing elective abdominal surgery, were randomly divided into 4 groups （n = 20 each）： control group （group S0 ） and 3 sufentanil groups （group S1,S2, S3 ）. The patients were unpremedicated. Anesthesia was induced with TCI of propofol （target plasma concentration 3.5 μg/ml） and TCI of remifentanil （Ce 4 ng/ml）. Tracheal intubation was facilitated with rocuronium 0.6 mg/kg after the patients lost consciousness. The patients were mechanically ventilated. And then propofol and remifentanil were immediately stopped and anesthesia was maintained with inhalation of sevoflurane and a mixture of nitrous oxide and oxygen, fresh gas flow set at 10 L/min maintaining for at least 20 min. In group So, sufentanil was not given after intubation. In group S1, S2 and S3, TCI of sufentanil was started after intubation at Ce of 0.12, 0.18 and 0.24 ng/ml respectively. In group S0, S1,S2 and S3, sevoflttrane inhalation was started with the initial end-tidal concentration of 3.0%, 1.8%, 1.3% and 1.1% respectively, The patients＇ response to skin incision was described as positive if MAP or HR increased by ≥ 25 %, or negative （ MAP or HR increased by 〈 25 % ）. If the response was positive, the end-tidal concentration of sevoflurane for the next patient was increased by 1.2 times, while if negative, decreased by 1.2 times. The sevoflurane MACBAR was determined by up-and-down sequential trial. Results Compared with group So, the MACBAR of sevoflurane was significantly decreased in group S1 , S2 and S3 （ P 〈 0.05）. Compared with group Sz, the MACBAR of sevoflurane was significantly decreased in group S2 and S3 （P 〈 0.05）. No significant difference was found in the MACBAR of sevoflurane between group S2 and S3 （ P 〈 0.05）. Conclusion TCI of sufentanil at Ce of 0.12, 0.18 and 0.24 ng/rrd can significantly reduce MACBAR of sevoflurane and enhance the inhibitory effect of sevoflurane on stress response in a concentration-dependent manner.