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三磷酸腺苷对术中瑞芬太尼用量的影响

Influence of Intravenous Infusion of Adenosine Triphosphate on Consumption of Remifentanil
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摘要 目的观察全身麻醉下行口腔颌面外科手术中给予静脉持续输注三磷酸腺苷(adenosine triphos-phate,ATP)对瑞芬太尼用量的影响。方法选择40例ASAⅠ~Ⅱ级择期行口腔颌面外科手术的患者,随机分为两组(n=20),三磷酸腺苷组(ATP组)和对照组(NS组)。入室后,监测ECG、NBP、MAP、HR、SpO2、BIS,10 min后,记录MAP、HR为基础值。全麻诱导:静脉注射咪达唑仑0.05 mg/kg、芬太尼3.0μg/kg、维库溴铵0.1 mg/kg、丙泊酚1.0 mg/kg,待BIS值达50时,行气管内插管,连接呼吸机行机械通气。维持:调节新鲜气流量1.0 L/min,潮气量8.0~10 mL/kg,呼吸频率12~14次/min,维持PETCO2在35~40 mmHg之间,吸入七氟烷,并维持MAC值为0.8,术毕停止吸入。两组均于手术开始时静脉输注瑞芬太尼0.05μg/(kg.min);同时ATP组静脉输注ATP 70μg/(kg.min),NS组按ATP组的注射容积速度0.007 mL/(kg.min)静脉输注生理盐水至术毕。术中根据BIS值以0.01~0.05μg/(kg.min)的幅度调整瑞芬太尼,使BIS值维持在40~50之间。记录:麻醉前(T0)、切皮即刻(T1)、切皮后15 min(T2)、切皮后30 min(T3)及术毕即刻(T4)的MAP和HR值;术中瑞芬太尼的平均用量;是否追加血管活性药及其用量;苏醒时间。结果两组患者性别、年龄、体重、手术时间、苏醒时间的比较,差异无统计学意义(P〉0.05);瑞芬太尼平均用量:ATP组0.049 2±0.007 1μg/(kg.min)〈对照组0.085 2±0.011 1μg/(kg.min),差异有统计学意义(P〈0.05);在T0~T4各时点,两组间MAP和HR的比较无统计学差异(P〉0.05)。结论全身麻醉下,口腔颌面外科手术中BIS值40~50时,静脉持续输注ATP 70μg/(kg.min)可以减少术中瑞芬太尼用量,且血流动力学稳定。 Objective To observe the effects of intraoperative continuous intravenous infusion of adenosine triphosphate on remifentanil consumption in patients for oral and maxillofacial surgery.Methods Forty ASA classⅠor Ⅱ patients scheduled for oral and maxillofacial surgery were randomized into 2 groups(n=20 each):group ATP and group NS.Patients allergic to adenosine,suffering from heart disease or conduction block,asthma were exclusion from the research.All patients were in stable intramuscular injection 30 minutes before surgery diazepam 10mg,atropine 0.5 mg.Monitoring ECG,blood pressure(NBP),mean arterial pressure(MAP),heart rate(HR),SpO2,PETCO2,MAC and bispectral index(BIS).Anesthesia induction: midazolam 0.05 mg/kg,fentanyl 3.0 μg/kg,vecuronium 0.1 mg/kg,propofol 1.0 mg/kg,when BIS value of 50 perform endotracheal intubation,mechanical ventilation,regulate the fresh gas flow rate 1L/min,tidal volume of 8.0~10 mL/kg,respiratory rate 12~14 beats/min to maintain end-tidal carbon dioxide partial pressure(PETCO2) at 35~40 mmHg.On the time of the surgery beginning,the patients received the continuous intravenous infusion of remifentanil 0.05 μg/(kg·min),at the same time adenosine triphosphate 70 μg/(kg·min) or normal saline 0.007 mL/(kg·min) were continuous intravenous infused respectivetly until the end of surgery.The value of minimal alveolar concentration was 0.8 with sevoflurane.The remifentanil was titrated to maintain a BIS target level between 40~50 and a stable hemodynamics.The following values were observed:changes of mean arterial pressure(MAP) and heart rate(HR) before induction of aneathesia(T0),0 min(T1),15 min(T2)and 30 min(T3) after incision,and at the end of surgery(T4);consumption of remifentanil;Whether in additional vasoactive drugs and their dosage;recovery time.Results There were no significant difference in sex,age,body weight,operative time,recovery time and MAP and HR at T0,T1,T2,T3 and T4 among each group(P0.05).Compared with groups NS,The average remifentanil consumption was lower in group ATP(P0.05).No vasoactive drugs were used in each group and no adverse reactions occurred.Conclusion Continuous intravenous infusion of adenosine triphosphate 70 μg/(kg·min) could spare remifentanil consumption.
作者 刘洋 邵贵骞
出处 《黑龙江医学》 2010年第9期653-656,共4页 Heilongjiang Medical Journal
关键词 全身麻醉 三磷酸腺苷 瑞芬太尼 用量 静脉内 Adenosine triphosphate Remifentanil Consumption General anesthesia Intravenous
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参考文献16

  • 1王世端,褚海辰,冯伟,潘维敏,董河.持续静脉输注ATP对腹部手术患者靶控输注异丙酚效应室浓度的影响[J].中华麻醉学杂志,2007,27(3):225-228. 被引量:2
  • 2Owall A,Jarnberg P O,Brodin L A,Sollevi A.Effects of adenosine induced hypotension on myocardial hemodynamics and metabolism in fentanyl anesthetized patients with peripheral vascular disease[J].Anesthesiology,1988,68:416-421.
  • 3Owall A,Lagerkranser M,Sollevi A.Effects of adenosine-induced hypo-tension on myocardial hemodynamics and metabolism during cerebral aneurysm surgery[J].Anesth Analg,1988,67:228-232.
  • 4Zarate E,Sa Rego M M,White P F,Duffy L,Shearer VE,Griffin JD,Whitten CW.Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia[J].Anesthesiology,1999,Apr(4):956-963.
  • 5Segerdahl M,Ekblom A,Sollevi A.The influence of adenosine,ketamine,and morphine on experimentally induced is chemic pain in healthy volunteers[J].Anesth Analg,1994,79:787-791.
  • 6Segerdahl M,Irestedt L,Sollevi A.Antinociceptive effect of perioperative adenosine infusion in abdominal hysterectomy[J].Acta Anaesthesia Scand,1997,41:473-479.
  • 7Segerdahl M,Ekblom A,Sandelin K.Peroperative adenosine infusion reduces the requirements for isoflurane and postopera tire analgesics[J].Anesth Analg,1995,80(6):1 145-1 149.
  • 8Segerdahl M,Persson E,Ekblom A.Perioperative adenosine infusion reduces isoflurane concentrations during general anesthesia for shoulder surgery[J].Acta Anesthesia Scand,1997,(9):1 226-1 227.
  • 9Fukunaga A F,Alexander G E,Stark C W.Characterization of the analgesic actions of adenosine:comparison of adenosine and remifentanil infusions in patients undergoing major surgical procedures[J].Pain,2003,101(1-2):129-138.
  • 10Belfrage M,Sollevi A,Segerdahl M,Sjolund K F,Hansson P.Systemic adenosine infusion alleviates spontaneous and stimulus evoked pain in patients with peripheral neuropathic pain[J].Anesth Analg,1995,81:713-717.

二级参考文献12

  • 1Murata K, Sodeyama O, Ikeda K, et al. Prevention of hypertensive crisis during anesthesia for pheochromcytoma. J Anesth, 1987,1:162-167.
  • 2Seitz PA, ter Riet M, Rush W, et al. Adenosine decreases the minimum alveolar concentration of halothane in dogs. Anesthesiology, 1990, 73: 990-994.
  • 3Segerdahl M, Ekblom A, Sandelin K, et al. Peroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics. Anesth Analg, 1995,80:1145-1149.
  • 4Segerdahl M, Persson E, Ekblom A, et al. Peroperative adenosine infusion reduces isoflurane concentrations during general anesthesia for shoulder surgery. Acta Anaesthesiol Scand, 1996 ;40: 792-797.
  • 5Belfrage M, Sollevi A, Segerdahl M, et al. Systemic adenosine infusion alleviates spontaneous and stimttlus evoked pain in patients with peripheral neuropathic pain. Anesth Analg,1995,81:713-717.
  • 6Fredholm BB, Dunwiddie TV. How dose adenosine inhibit transmitter release? Trends Pharmacol Sci, 1988,9 : 130-134.
  • 7Swinhoe CF, Peacock JE, Reilly CS. Evaluation of the accuracy of the Diprifusor'. Eur J Anaethesiol Suppl, 1995,10: 84.
  • 8Segerdahl M, Ekblom A, Sollevi A. The influence of adenosine, ketamine, and morphine on experimentally induced ischemic pain in healthy volunteers. Anesth Analg , 1994,79 : 787-791.
  • 9Segerdahl M, Irestedt L, Sollevi A. Antimociceptive effect of perioperative adenosine infusion in abdominal hysterectomy. Acta Anaesthesiol Scand, 1997,41 : 473-479.
  • 10Fukunaga AF, Alexander GE, Stark CW. Characterization of the analgesic actions of adenosine: comparison of adenosine and remifentanil infusions in patients undergoing major surgical procedures. Pain, 2003, 101:129-138

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