不同血浆靶浓度瑞芬太尼对患者异丙酚镇静效应的影响

Effect of different target plasma concentrations of remifentanll on sedative effect of propofol

目的 探讨不同血浆靶浓度瑞芬太尼对患者异丙酚镇静效应的影响.方法 择期拟行腹腔镜胆囊切除术患者80例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄18～60岁,随机分为4组,每组20例.麻醉诱导：Ⅱ～Ⅳ组靶控输注瑞芬太尼,血浆靶浓度分别设为2、4、8 ng/ml,Ⅰ～Ⅳ组均靶控输注异丙酚,初始血浆靶浓度为2μg/ml,随后每间隔1min增加0.5μg/ml,直至BIS值下降至50.患者意识消失时记录BIS值和异丙酚血浆靶浓度,BIS值降至50时记录异丙酚血浆靶浓度及异丙酚总用量.结果 与Ⅰ组比较,Ⅲ组和Ⅳ组患者意识消失时BIS值升高,异丙酚血浆靶浓度降低,BIS值降至50时异丙酚总用量和异丙酚血浆靶浓度降低（P＜0.05）.结论 复合异丙酚麻醉时,瑞芬太尼适宜血浆靶浓度为4 ng/ml.

Objective To investigate the effect of different target plasma concentrations （Cp） of remifentanil on sedative effect of propofol. Methods Eighty adult ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing elective laparoscopic cholecystectomy were randomly assigned into 4 groups （n = 20 each）. Anesthesia was induced with TCI of remifentanil （Cp = 2, 4 and 8 ng/ml in group Ⅱ-Ⅳ respectively） and propofol TCI （the initial Cp of propofol was 2 μg/ml in the 4 groups）. Then the Cp of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and the Cp of propofol were recorded as the patient lost consciousness.The Cp and consumption of propofol were recorded when BIS value decreased to 50. Results BIS value was significantly increased, while the Cp of propofol was significantly decreased as the patient lost consciousness, and the Cp and consumption of propofol were significantly decreased when BIS value decreased to 50 in group Ⅲ - Ⅳ compared with group Ⅰ （P 〈 0.05）. Conclusion Remifentanil 4 ng/ml is the suitable Cp for anesthesia when combined with propofol.