雷米芬太尼对丙泊酚靶控输注诱导期间效应室浓度及麻醉深度的影响

Effect of remifentanil on the effect compartment concentration and anesthesia depth during propofol target-controlled infusion period

目的：观察丙泊酚靶控输注（ TCI）诱导期间泵注雷米芬太尼对丙泊酚效应室浓度（ EC）、熵指数和心血管反应的影响。方法：将择期手术患者22例,随机均分为观察组和对照组。2组均以血浆血药浓度为靶目标进行TCI,丙泊酚靶控血药初始浓度设为1.5μg/ml,每4 min增加0.5μg/ml,当改良警觉/镇静评分（MOAA/S）为1分时,对照组和观察组分别静脉泵入0.9%氯化钠注射液和雷米芬太尼0.2μg·kg-1·min-1,当MOAA/S为0分时给予肌松药3 min后行气管插管。观察记录丙泊酚EC、熵指数[反应熵（ RE）、状态熵（ SE）]、平均动脉压（ MAP）和心率（ HR）,于诱导前（ T0）、气管插管前3 min即给肌松药时（T1）、插管即刻（T2）、插管后1 min（T3）。结果：观察组T1-T3丙泊酚EC均低于对照组（P〈0.05-P〈0.01）。2组T1-T3 RE和SE差异均无统计学意义（P〉0.05）。观察组T3 MAP和T1-T3 HR均明显低于对照组（P〈0.01）。结论：丙泊酚TCI诱导期间泵入雷米芬太尼使麻醉深度不变的情况下丙泊酚用量明显减少,血压和HR被抑制更明显。

Objective：To investigate the effect of remifentanil on the effect compartment concentration（ EC） ,response entropy（ RE） , state entropy（SE） and hemodynamical response during propofol target-controlled infusion（TCI） general anesthesia period. Methods：Twenty-two ASA classⅠ - II patients undergoing elective surgery were randomly divided into the experimental group and control group,eleven cases in each group. In the two groups,the plasma concentration was as the target objective to do TCI. The initial plasma concentration was set to 1. 5μg /ml,increased by 0. 5μg /ml every 4 minutes until the Modified Observer Assessment of Alertness and Sedation（MOAA/S） score=1. The patients in experimental group were received with remifentanil infusion at 0. 2 μg·kg^-1·min^-1, while the patients in control group were received with normal saline at 0. 2 μg·kg^-1 ·min^-1 . Tracheal intubation was operated after 3 minutes with muscular relaxants when MOAA/S was equal to 0. Propofol EC,RE,SE,mean arterial pressure（MAP） and heart rate （ HR） were recorded when anesthesia was inducted with propofol TCI, including before anesthesia （ T0 ） , at the time of infusion with muscle relaxants（T1）,at the time of intubation（T2） and at 1 min after intubation（T3）. Results：Propofol EC in experimental group was lower than that in control group at T1 -T3（P〈0. 05 to P〈0. 01）. There was no significant difference of RE and SE at T1 -T3 between the two groups（P〉0. 05）. MAP at T3 and HR at T1 -T3 in experimental group were lower than those in control group（P〈0. 01）. Conclusions：The doseage of propofol was decreased obviously during induction of general anesthesia by infusing remifentanil and propofol. At same time,HR and BP were inhibited obviously,but no changes of RE and SE.