不同靶浓度的瑞芬太尼用于七氟醚吸入诱导的对比观察

Observation of different plasma concentration of remifentanil combined with sevoflurane in inhalation general anesthesia induction

目的在脑电双频指数(BIS)的监测下,比较不同血浆靶浓度的瑞芬太尼复合七氟醚麻醉诱导对血流动力学的影响,探讨瑞芬太尼合适的麻醉诱导剂量。方法择期全麻手术患者60例,按瑞芬太尼靶浓度不同随机分为3组:3 ng/ml(D1组)、4 ng/ml(D2组)和5 ng/ml(D3组),每组20例。3组均采用七氟醚吸入麻醉诱导。当BIS值达60时静注顺式阿曲库铵辅助插管。分别记录诱导前(T1)、插管前(T2)、插管即刻(T3)、插管后3 min(T4)的平均动脉压(MAP)和心率(HR),以及各组患者意识消失的时间。结果与T1相比,T2各组MAP和HR均有下降,但D3下降更明显(P<0.05);T3时D1组MAP和HR显著快于T1、T2(P<0.05)。3组患者意识消失的时间相比差异无统计学意义。结论靶控输注4ng/ml的瑞芬太尼复合七氟醚诱导血流动力学更平稳,此剂量的瑞芬太尼为合适的诱导剂量。

Objective This experiment was trying to compare the hemodynamic effect of patients with general anesthesia induction of sevoflurane combined with different remifentanil plasma concentration under monitoring of bispectral index（BIS）.And to figure out the proper dosage of remifentanil for general anesthesia induction. Methods Sixty patients waiting for the selective operation with general anesthesia were separated randomly into 3 groups according to target plasma concentration of remifentanil：3ng/ml（D1）、4ng/ml（D2）and 5ng/ml（D3）, （n=20each）.All of 3 groups combined with sevoflurane for the general anesthesia induction.and took tracheal intubation after Cisatracurium Besilate injection when BIS came to 60.To record the mean blood pressure（MAP）,heart rate（HR） at the time points of before anesthesia induction（T1）, before intubation（T2）,intubation time（T3）,3min after intubation（T4） and to record the time of consciousness lost. Results Compared with the time points of before anesthesia induction（T1）, the mean blood pressure （MAP）and heart rate（HR） of all the 3 groups at the time points of before anesthesia induction（T1） was lower.and particularly evident in D3（P〈0.05）.The MAP and HR of D1 group’s patients at the time points of intubation time（T3） were markedly faster than that at the time points of before anesthesia induction（T1）, before intubation（T2）（P〈0.05）.There was no significant difference in the consciousness lost time of all the 3 groups. Conclusion Target-controlled infusion（TCI） of remifentanil at target plasma concentration of 4ng/ml is the proper dosage for the general anesthesia induction combined with sevoflurane,which can get a more stable hemodynamic effect.