布托啡诺与芬太尼对全凭静脉麻醉中诱导期脑电双频指数与异丙酚效应室浓度曲线的影响

Effects of butorphanol and fentanyl on the BIS-propofol effect-site concentration curve during total intravenous anesthesia induction

目的 探讨布托啡诺与芬太尼在全凭静脉麻醉中诱导期对脑电双频指数（BIS）与异丙酚效应室浓度曲线的影响.方法 本院2009年2月至5月择期在全凭静脉麻醉下行甲状腺、乳腺手术患者112例,美国麻醉师协会（ASA）Ⅰ或Ⅱ级,完全随机分4组：对照组（C组）、芬太尼组（F组）、布托啡诺组（B组）和布托啡诺芬太尼组（BF组）,每组28例.各组均靶控输注异丙酚进行诱导.C组意识消失后,静脉推注芬太尼4 μg/kg、顺式阿曲库铵0.2 mg/kg;F组诱导前2 min推注芬太尼4μg/kg,B组诱导前5 min推注布托啡诺40μg/kg,BF组诱导前5、2 min分别推注布托啡诺20 μg/kg、芬太尼2 μg/kg,诱导后均推注顺式阿曲库铵0.2 mg/kg,气管插管机械通气.记录异丙酚各效应室浓度（Ce）所对应的BIS值,绘制成曲线图.结果 在异丙酚各效应室浓度时,F组BIS值低于C组（68±14比76±12,P=0.036））;B组BIS值低于F组（61±11比68±14,P=0.041）.异丙酚效应室浓度小于1.4mg/L时,B组BIS值高于BF组（P=0.045）;异丙酚效应室浓度大于1.4 mg/L时,B组BIS值低于BF组（P=0.036）.各组患者达到全身麻醉状态的顺序是：B组、BF组、F组、C组.结论 布托啡诺、芬太尼均可降低诱导时的BIS值,布托啡诺降低的程度更大.异丙酚Ce小于1.4mg/L时,布托菲诺芬太尼联合应用降低BIS值最明显.

Objective To compare the effects of butorphanol and fentanyl on the bispectral index （BIS）-propofol effect-site concentration curve during total intravenous anesthesia induction. Methods One hundred and twelve patients, scheduled for selective surgery of the thyroid or breast between February 2009 and May 2009 in our hospital under total intravenous anesthesia （ASA Ⅰ-Ⅱ）, were randomly divided into four groups： control group （Group C） , fentanyl group （Group F） , butorphanol group （Group B） , and butorphanol plus fentanyl group （Group BF） , 28 patients in each group. Target controlled infusion of propofol was used for anesthesia induction in all groups. Group C received an intravenous （Ⅳ） bolus of 4 μg/kg fentanyl and 0.2 mg/kg cis-benzene atracurium after loss of consciousness. Group F was given an Ⅳ bolus of 4 μg/kg fentanyl at two minutes before induction; Group B was given an Ⅳ bolus of 40 μg/kg butorphanol at five minutes before induction; Group BF was given an Ⅳ bolus of 20 μg/kg butorphanol at five minutes and fentanyl 2 μg/kg at two minutes before induction. Moreover, a post-induction Ⅳ bolus of 0.2 mg/kg cis-benzene atracurium was given to groups B, F and BF. Endotracheal intubation was used for mechanical ventilation. Bispoctral index （BIS） and corresponding effect-site concentrations （Ce） of propofol were recorded and graphed. Results At each corresponding effect-site concentration, the bispectral indexes were lower in Group F compared to Group C （68±14 vs 76±12, P=0.036）, and in Group B compared to Group F （61±11 vs 68±14, P=0.041）. Compared with the Group BF, Group B had a higher BIS when the effect-site concentration of propofol was below 1.4 mg/L, and a lower BIS when the effect-site concentration of propofol was above 1.4 mg/L. The group B was the quickest to fulfill the sedation level required of surgery,followed by Group BF, Group F and Group C. Conclusions Both butorphanol and fentanyl may reduce the BIS at each corresponding effect-site concentration of propofol, with greater reduction of BIS by butorphanol.Butorphanol plus fentanyl may lead to the greatest reduction in BIS when the effect-site concentration of propofol is below 1.4 mg/L.