麻醉诱导期间靶控输注舒芬太尼对丙泊酚镇静作用的影响

Effect of Sufentanil Target-controlled Infusion on Propofol-induced Sedation During Induction

目的:探讨麻醉诱导期间不同浓度舒芬太尼对睫毛反射、意识消失时丙泊酚血药浓度的影响。方法:选择40例择期手术患者靶控输注舒芬太尼、丙泊酚全凭静脉麻醉,根据舒芬太尼目标浓度将患者分为4组,分别为0ng·mL-(1A组)、0.2ng·mL-(1B组)、0.4ng·mL-(1C组)、0.8ng·mL-(1D组),每组10例。应用高效液相色谱-质谱联用法测定舒芬太尼血药浓度,反相高效液相色谱法测定丙泊酚血药浓度。结果:麻醉诱导睫毛反射与意识消失时,单用丙泊酚血药浓度分别为2.74μg·mL-1、3.87μg·mL-1;舒芬太尼靶浓度从0.2ng·mL-1升至0.8ng·mL-1,睫毛反射消失时丙泊酚血药浓度从2.67μg·mL-1降至1.58μg·mL-1、意识消失时从3.90μg·mL-1降至2.61μg·mL-1;舒芬太尼与丙泊酚在睫毛反射、意识消失时的量效关系均呈直线关系;D组分别与A、B组比较,在睫毛反射与意识消失时丙泊酚的效应室浓度均明显减少(P<0.05);D组与C组比较,在睫毛反射消失时丙泊酚的效应室浓度也明显减少。结论:麻醉诱导期舒芬太尼与丙泊酚在镇静催眠作用方面表现为相加作用,舒芬太尼靶浓度0.4～0.8ng·mL-1时可明显降低丙泊酚在睫毛反射与意识消失时的血药浓度,推荐临床应用舒芬太尼靶浓度0.4～0.8ng·mL-1为宜。

OBJECTIVE：To probe into effect of sufentanil at different concentrations on plasma concentration of propofol at the moment of the loss of eyelash reflex and consciousness. METHODS：40 selective patients underwent sufentanil target- controlled infusion and propofolinduced sedation. They were divided into four groups according to the target concentration of sufentanil such as group A（0 ng·mL -1）,group B（0.2 ng·mL-1）,group C（0.4 ng·mL-1）and group D（0.8 ng·mL-1）with 10 patients in each group.HPLC-MS and RP-HPLC were applied to detect the plasma concentrations of sufentanil and propofol.RESULTS：Plasma concentration of propofol was 2.74μg·mL-1when patients lost eyelash reflex and it was 3.87μg·mL-1when patients was unconsciousness.With target sufentanil concentrations increasing from 0.2 ng·mL-1to 0.8 ng·mL-1,the plasma concentration of propofol was decreased from 2.67μg·mLto 1.58μg·mLwhen patients lost eyelash reflex and it was decreased from 3.90μg·mL-1to 2.61μg·mL-1when patients was unconsciousness.Both the interaction curves at the moment of the loss of eyelash reflex and consciousness were best fitted with the straight.The effect compartment concentrations of propofol in group D were markedly lower than that in group A and B when patients loss eyelash reflex and consciousness（P0.05）.And the effect compartment concentrations of propofol in group D were markedly lower than that in group C while patients loss eyelash reflex.CONCLUSION：Sufentanil contributes to propofol-induced sedation.The target concentrations of sufentanil of 0.4～0.8 ng·mL-1 significantly reduce plasma concentration of propofol at the moment of the lost of eyelash reflex and consciousness.The appropriate concentration of sufentanil is 0.4～0.8 ng·mL-1 in the clinic.