靶控输注雷米芬太尼对于依托咪酯诱导肌阵挛的预防作用

Role of Target Controlled Infusion of Remifentanil for the Prevention of Etomidate Induced Myoclonus during General Anesthesia

目的探讨靶控输注不同质量浓度雷米芬太尼预防依托咪酯诱导肌阵挛的效果。方法全身麻醉下行择期手术的患者120例,根据麻醉诱导时靶控输注雷米芬太尼的不同质量浓度随机均分为4组,采用血浆靶控输注方式(Minto模型),分别设定目标质量浓度为1、2、3、4μg/L,达到效应室平衡后5 min,给予依托咪酯0.3 mg/kg静脉诱导,观察肌阵挛的强度及持续时间。结果 1、2、3、4μg/L组肌阵挛的发生率分别为70.9%、33.3%、26.7%、0。随着雷米芬太尼质量浓度的升高,重度肌阵挛逐渐减少;与1μg/L组比较,2、3μg/L组的效果最明显(P<0.05);当雷米芬太尼的质量浓度为4μg/L时,患者出现窦性心动过缓及呼吸停止。结论靶控输注雷米芬太尼可降低因依托咪酯全身麻醉诱导所发生的肌阵挛,雷米芬太尼的质量浓度为2～3μg/L效果最好。

Objective To explore the preventive effect of etomidate-induced myoclonus by different concentrations of target-controlled infusion of remifentanil. Methods A total of 120 cases undergoing genenal anesthesia were randomly divided into 4 groups according to different concentrations of target controlled infusion of remifentanil using plasma target controlled infusion （ Minto model）, in which the target concentration was set as 1 μg/L （ group A）, 2 μg/L （ group B）, 3 μg/L （ group C）, and 4 μg/L （ group D）. Five minutes after the balance of effect compartment, induction with etomidate 0.3 mg/kg was conducted intravenously. The in- tensity and duration of myoclonus was recorded. Results The incidence of etomidate-induced myoclonus was 70.9%, 33.3%, 26.7% , and 0 in groups A, B, C, and D, respectively. Along with the increase of the remifentanil concentration, the incidence of severe myoclonus gradually reduced, which was significantly lower in group B and C than in group A （ P 〈 0.05 ）. When the concentration reached 4 μg/L, bradycardia and apnea appeared. Conclusion Myoclonus induced by etomidate under general anesthesia can be prevented by target controlled infusion of remifentanil, with 2-3 μg/L being the optimal concentration.