舒芬太尼配伍七氟醚抑制切皮反应的有效性和安全性

Efficacy and safety of sufentanil combined with sevoflurane on inhibiting the skin incision reaction

目的:对比不同浓度靶控舒芬太尼配伍七氟醚在切皮时血流动力学及BIS值的变化,探讨联合应用时安全有效的配伍剂量。方法:择期腹部手术患者80例,ASAⅠ～Ⅱ级,年龄20～60岁,随机分为4组(n=20),S0,S1,S2,S3组切皮时七氟醚浓度分别为2.3%,1.6%,1.1%,0.9%,舒芬太尼Ce分别为0,0.12,0.18,0.24ng/mL。所有患者用丙泊酚(Cp3.5μg/mL)、瑞芬太尼(Ce4ng/mL)和罗库溴胺(0.6mg/kg)行麻醉诱导,气管插管后立即停用丙泊酚和瑞芬太尼,吸入七氟醚、60%笑气和40%氧气,各组分别将七氟醚和舒芬太尼调至设定浓度。比较四组间及组内切皮前后MAP、HR和BIS的变化。结果:组间比较,MAP无统计学差异(P>0.05);与S0组比较,S1、S2、S3组HR降低(P<0.05);与S0组比较,S2、S3组BIS值升高(P<0.05)。组内切皮后均值与切皮前均值相比,四组MAP均升高(P<0.05);S0组HR升高(P<0.05);S3组BIS值升高(P<0.05)。结论:舒芬太尼Ce0.12ng/mL配伍1.6%七氟醚以及舒芬太尼Ce0.18ng/mL配伍1.1%七氟醚可以安全有效地抑制切皮反应,是切皮阶段适宜的复合麻醉配伍浓度。

Objective To investigate the changes of hemodynamics and BIS in blunting surgical incision targeted controlled by sufentani[ combined with sevoflurane, at different concentrations, and to explore the optimum combined doses. Method 80 patients undergoing abdominal operation, ASA Ⅰ - Ⅱ , 20 - 60 year old,, were randomly divided into 4 groups （n = 20 cases）： So, S1, S2, S3. In skin incision, the concentrations of sevoflurane were 2.3%, 1.6%, 1.1% ,0,9% in S0, S1, S2, S3 group respectively , and the concentrations of sufentanil were 0,0.12 ng/mL, 0.18 ng/mL, 0.24 ng/mL respectively. Anesthesia was induced with propofol（Cp 3.5μg/mL）, remifentanil（Ce 4 ng/ mL）and rocuronium （0.6 mg/kg）for all patients. After intubation, the propofol and remifentanil were immediately stopped and the lungs were ventilated with sevoflurane and a mixture of 60% nitrous oxide and 40% oxygen,The concentrations of sufentanil and sevoflurane were adjusted to targeted concentrations.The changes of MAP,HR and BIS were compared before and after incison among groups and within every group.Results MAP was not significant different among groups（P 〉 0.05） ;HR in St,S2 and S3 group were lower than in So group（P 〈 0.05） ,and BIS increased in S2 and S2 group（P 〈 0.05）. Before and after incison within every group, MAP increased in S0,S1,S2 and S3 group （P 〈 0.05） ;HR increased in So group （P 〈 0.05） ; BIS increased in S3 group （P 〈 0.05）. Conclusion Targeted concentration 0.12 ng/mL sufentanil combined with 1.6% sevoflurane and targeted concentration 0.18 ng/mL sufentanil combined with 1.1% sevoflurane can effectively and safely blunt the adrenergic response to abdominal incision, which was the suitable combined concentration during abdominal incision period.