计算机模拟瑞芬太尼浓度与动脉血压变异、心率变异的相关性研究

Correlation of computer-simulated remifentanil concentration with blood pressure variability and heart rate variability

目的确定动脉血压变异性（BPV）、心率变异性（HRV）与计算机模拟瑞芬太尼浓度的相关性,评价BPV和HRV判断镇痛程度准确性。方法选择ASA分级Ⅰ~Ⅱ择期手术患者12例,诱导时给予依托咪酯0.3mg.kg-1,瑞芬太尼靶控浓度（Ct）1μg.L-1,意识消失后给予哌库溴铵0.6 mg.kg-1,行气管内插管,插管后以靶控输注（TCI）瑞芬太尼1μg.L-1递增,平衡10 min以上,直至达到7μg.L-1,分别记录麻醉诱导前、TCI瑞芬太尼Ct 1、2、3、4、5、6、7μg.L-1后,给予强直电流刺激时患者心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、HRV及BPV。结果随TCI瑞芬太尼浓度增加,HF、HRV、HR、BP及BPV与清醒时相比出现先升高后降低的趋势,HRV呈线性负相关,与收缩压变异性（SBPV）、舒张压变异性（DBPV）呈负相关。结论 BPV和HRV与瑞芬太尼浓度呈负相关,可作为判断麻醉中镇痛程度的可靠指标。

Objective To ascertain the correlation of computer-simulated remifentanil concentration with blood pressure variability（BPV） and heart rate variability（HRV） and to evaluate the accuracy of BPV and HRV as guideline to analgesia.Methods 12 ASA Ⅰ–Ⅱ patients scheduled for operation underwent induction with etomidate 0.3 mg·kg-1,target-controlled infusion（TCI） of remifentanil concentration（Ct） 1 μg·L-1.When patients lost consciousness,pipecuronium 0.6 mg·kg-1 was used for tracheal intubation,followed by TCI of remifentanil increase by degree of 1 μg·L-1,balancing for at least 10 minutes,until 7 μg·L-1.The HR,systolic pressure（SP）,diastolic pressure（DP）,mean arterial pressure（MAP） and BPV were recorded before anesthesia induction,and after TCI remifentanil Ct 1,2,3,4,5,6 and 7 μg·L-1 as well as during stiff electric stimulation.Results With the increase of remifentanil concentrations,the HF,HRV,HR,BP and BPV were in a tendency of increase and subsequent decrease,compared with the conscious condition,and HRV presented negative linear correlation.Similarly negative correlation can be observed between remifentanil concentration and SBPV and DBPV.Conclusion BPV and HRV are negatively correlated with the concentration of remifentanil,and can serve as criteria to judge the analgesia degree during anesthesia.