不同靶浓度瑞芬太尼复合丙泊酚对妇科开腹手术患者七氟烷MACBAR的影响

Effects of different target concentrations Remifentanil combined with Propofol on MACBAR of Sevoflurane in patients undergoing gynecological laparotomy

目的:评价不同靶浓度瑞芬太尼复合丙泊酚对七氟烷抑制50%妇科开腹手术患者切皮诱发应激反应的最低肺泡有效浓度(MACBAR)的影响。方法:择期拟行妇科开腹手术患者120例随机分为4组,各30例,SA组不使用瑞芬太尼;SB组、SC组和SD组瑞芬太尼效应室浓度分别为1.5、2.0和2.5μg/L。气管插管后吸入七氟烷和血浆浓度为1.5μg/ml的丙泊酚TCI,新鲜气流量8 L/min。SA组气管插管后不给予瑞芬太尼,其余组分别按设定目标靶浓度输注瑞芬太尼。根据序贯法进行试验,SA组、SB组、SC组和SD组初始呼气末七氟烷浓度分别为2.8%、1.5%、1.2%和0.9%,根据患者对切皮的反应(切皮时MAP和HR中任何一项升高幅度≥切皮前的25%为阳性反应)以1.2倍等比级增减,计算七氟烷MACBAR。结果:SA组七氟烷MACBAR为2.1%(1.8%～2.3%),SB、SC和SD组七氟烷MACBAR是1.5%(1.3%～1.6%)、1.1%(1.0%～1.2%)和0.8%(0.7%～0.9%)。与SA组比较,SB组、SC组和SD组七氟醚MACBAR均降低(P<0.05);与SB组比较,SC组和SD组七氟醚MACBAR均降低(P<0.05);SD组与SC组比较MACBAR又降低(P<0.05)。结论:复合丙泊酚靶控输注时瑞芬太尼靶控效应室靶浓度1.5、2.0和2.5μg/L均可降低七氟烷MACBAR,增强七氟烷抑制应激反应的效应,且呈浓度依赖性。

Objective： To investigate the effects of three different plasma effect-site concentration（Ce） of Remifentanil given by TCI on the minimum alveolar concentration of Sevoflurane for blunting adrenergic responses to skin incision（MACBAR） in patients undergoing gynecological laparotomy with TCI of Propofol.Methods： 120 patients undergoing elective gynecological laparotomy were randomly divided in 4 groups（30 cases each）,control group（group SA） and 3 Remifentanil gro ups（group SB,SC,SD）.The patients were unpremedicated.Anesthesia was induced with TCI of Propofol（target plasma concen tration 3.0 ug/ml） and TCI of Remifentanil（Ce 4 μg/L）.Tracheal intubation was facilitated with rocuronium 0.6 mg/kg after the patients lost consciousness.The patients were mechanically ventilated.And then anesthesia was maintained with inhalation of Sevoflurane and TCI of Propofol（target plasma concentration 1.5 μg/ml）,fresh gas flow set at 8 L/min maintaining for at least 20 min.In group SA Remifentanil was not given after intubation.In group SB,SC and SD,Remifentanil was given at Ce of 1.5,2.0 and 2.5 μg/L respectively.In group SA,SB,SC and SD,Sevoflurane inhalation was started with the initial end-tidal concentration of 2.8%,1.5%,1.2% and 0.9% respectively.The patients’ response to skin incision was described as positive if MAP or HR increased by ≥25%,or negative（MAP or HR increased by 〈25%）.If the response positive,the end-tidal concentration of Sevoflurane for the next patient was increased by 1.2 times,while if negative,deceased by 1.2 times.The Sevoflurane MACBAR was determined by up-and-down sequential trial.Results： In group SA,SB,SC and SD,the MACBAR of Sevoflurane was 2.1%（1.8%-2.3%）,1.5%（1.3%-1.6%）,1.1%（1.0%-1.2%） and 1.1%（1.0%-1.2%）.Compared with group SA,the MACBAR of Sevoflurane significantly decreased in group SB,SC and SD（P〈0.05）.Compared with group SB,the MACBAR of Sevoflurane was decreased in group SC（P〈0.05）.Compared with group SC,the MACBAR of Sevoflurane decreased in group SD（P〈0.05）.Conclusion： Compounded with TCI of Propofol,TCI of Remifentanil at Ce of 1.5,2.0 and 2.5 μg/L can significantly reduce MACBAR of Sevoflurane and enhance the inhibitory effect of Sevoflurane on stress response in a concentration-dependent matter.