丙泊酚靶控输注麻醉诱导时复合芬太尼对患者效应室丙泊酚浓度和血流动力学的影响

Influence of Target-controlled Infusion of Propofol Combined with Fentanyl on the Effect-site Concentration of Propofol and Hemodynamics during Induction of Anesthesia

目的研究丙泊酚靶控输注麻醉诱导时复合芬太尼对患者效应室浓度及血流动力学的影响.方法70例患者分为丙泊酚组(P组,n=35)和芬太尼组(F组,n=35).2组患者均用丙泊酚靶控诱导;F组在输注丙泊酚前3 min静脉注射芬太尼2μg/kg,P组不使用芬太尼.分别记录麻醉诱导开始前(T1)、意识消失时即睫毛反射消失时(T2)、气管插管完成时(T3)患者的平均动脉压及心率.记录开始TCI输注丙泊酚至患者意识消失的时间、意识消失时的效应室丙泊酚浓度以及开始TCI输注丙泊酚至插管完成时两组患者的丙泊酚用量.结果P组T2时间点平均动脉压及心率较T1显著降低,T3较T1明显升高;F组T2时间点平均动脉压及心率较T1显著降低.F组从TCI输注丙泊酚开始至患者意识消失所需的时间、丙泊酚的效应室浓度和丙泊酚剂量均较P组明显降低.结论 2μg/kg的芬太尼可以降低患者意识消失的丙泊酚效应室浓度,缩短诱导时间,减少丙泊酚的使用量,有效的抑制插管引起的心血管反应,使诱导过程中患者的血流动力学更加稳定.

Objective To study the influence of target-controlled infusion of propofol combined with fentanyl on the effect-site concentration of propofol and hemodynamics during induction of anesthesia. Methods Seventy patients were randomly divided into two groups（group P and group F）,35 patients each. Group F received fentanyl2 μg/kg 3 min intravenously before the infusion of propofol,while group P did not receive fentanyl. Before induction of anesthesia（T1）, at the time of the loss of consciousness（T2） and the time of tracheal intubation（T3） in each group, the mean arterial pressure（MAP） and heart rate（HR） were recorded. The time from the infusion of propofol to the loss of consciousness,the effect-site concentration of propofol at the time of the loss of consciousness and the dosage of propofol when intubation finished were recorded, respectively.Results MAP and HR were lower significantly at T2 and much higher at T3 compared with T1 in group P, and MAP and HR were lower significantly at T2 compared with T1 in group F. The time from the infusion of propofol to the loss of consciousness,the effect-site concentration of propofol at the time of the loss of consciousness and the dose of propofol when intubation finished were lower significantly in group F than those in group P.Conclusion The dose of 2μg/kg fentanyl can be used to decrease the effect-site concentration of propofol,shorten the time of induction, reduce the dose of propofol,and make the hemodynamics much more stable during the induction.