航海刺激对瑞芬太尼复合丙泊酚靶控输注麻醉深度及苏醒质量的影响

Effect of Navigation Stimulation on Anesthetic Depth and Revival Quality during Anesthesia with Target Controlled Infusion of Propofol and Remifentanyl

目的探讨航海刺激对瑞芬太尼复合丙泊酚靶浓度控制输注（target controlled infusion，TCI）麻醉深度及苏醒质量的影响。方法40例择期全身麻醉手术患者随机分成旋转组（rotation group，R组，20例）和对照组（control group，C组，20例）。R组采用旋椅试验制备运动病临床模型，C组不行旋转刺激。麻醉诱导采用以血浆药物浓度为靶目标进行丙泊酚TCI，靶浓度（Ct）为4μg／ml，同时静脉泵注瑞芬太尼1μg／kg，待患者意识消失后静注罗库溴铵0．6mg／kg，吸纯氧3min后气管内插管。术中以瑞芬太尼0．2μg／（kg·min）维持麻醉，调节丙泊酚TCI的Ct值，使状态熵（state entropy，SE）维持在（50±3）。记录入室各指标基础值（T0），麻醉诱导前（T1），气管插管后5min（T2），手术开始即刻（T3），手术开始后10min（T4）、30min（T5）、60min（T6）、90min（T7）的反应熵（response entropy，RE）、SE、平均动脉压（mean artery pressure，MAP）、心率（heart rate，HR）及丙泊酚Ct值。观察患者麻醉清醒时间、拔管时间、拔管时和拔管后10min的MAP、HR以及疼痛评分、镇静-躁动评分、全麻后身体舒适度评分、术后恶心呕吐（postoperative nausea and vomiting，PONV）发生率等。结果R组T2～T7时Ct值均明显低于C组（P〈0．01），降幅为11．68％～15．28％；HR明显减慢并于T4～L时显著低于C组（P〈0．01），有2例需用阿托品纠正。R组拔管时和拔管后10min的MAP、HR以及视觉模拟评分法（visual analogue scale，VAS）评分均明显低于C组（P〈0．01），但清醒时间和拔管时间明显长于C组（P〈0．01或P〈0．05），镇静-躁动评分为（2．56±1．76），明显低于C组（P〈0．01）。结论航海刺激可增加患者瑞芬太尼复合丙泊酚TCI麻醉的敏感性，减轻苏醒期的疼痛及血流动力学波动，但可降低苏醒质量（清醒程度）。

Objective To evaluate the effect of navigation stimulation on the anesthetic depth and revival quality during anesthesia with target controlled infusion （TCI） of propofol and remifentanyl. Methods Forty patients （ASA Ⅰ-Ⅱ ） scheduled for elective operation under general anesthesia were randomly divided into rotation group（group R, 20 cases） and control group（group C, 20 cases）. In group R, rotation-chair test was utilized to establish clinical model of motion sickness （MS）. In group C,patients underwent no rotation. Anesthesia was induced by TCI with propofol 4μg/ml and remifentanyl 1μg/kg. After the patients lost consciousness, they were intravenously injected with rocuronium 0. 6 mg/kg and were intubated,then infused with remifentanyl at 0. 2μg/（kg.min） and propofol infusion （Ct） was titrated to maintain the state entropy（SE） value at 50 ± 3. The parameters of response entropy （RE）, SE, mean arterial pressure （MAP）, heart rate （HR） and Ct were recorded in baseline （T0）, before anesthesia （T1）, 5 minutes after intubation （T2）, at the beginning of the operation （T3）, 10 （T4） ,30 （T5） ,60 （T6） and 90 minutes after operation （T7）. The time of revival and extubation, MAP and HR at extubation and at 10 minutes after extubation, the analgesic score （visual analogue scale,VAS）, sedative-restless score, comfortable score and the incidence rate of postoperative nausea and vomiting （PONV） were observed. Results Ct in group R was 11.68%-15.28% lower than that in group C from T2 to T7 （P〈 0. 01）. HR was significantly reduced in group R and lower than that in group C from T4 to T6 （P〈0. 01） and two patients in group R needed atropine. The MAP,HR and VAS in group R were lower than those in group C at extubation and 10minutes after extubation （P〈0. 01）. The time of revival and extubation in group R was longer （P〈0. 01,0. 05）, and the sedative-restless score （2. 56 ± 1.76） was lower than that in group C （P〈0. 01）. Conclusion During anesthesia with TCI of propofol and remifentanyl, navigation stimulation can obvious increase the anesthetic sensitivity, alleviate the analgesic score and hemodynamic undulation during revival as well as reduce the revival quality （consciousness degree）.