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.
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