艾司洛尔对全凭静脉麻醉中瑞芬太尼用量的影响

Influence of Esmolol on the Dosing of Remifentanil in Total Intravenous Anesthesia

目的:探讨艾司洛尔对全凭静脉麻醉中瑞芬太尼用量的影响。方法:将40例择期在全凭静脉麻醉下行甲状腺手术的女性患者随机分为2组,每组20例。试验组气管插管后静脉持续输注负荷量艾司洛尔,并维持至拔管后;对照组用等容量0.9%氯化钠溶液代替艾司洛尔。术中根据脑电双频指数调整异丙酚靶控浓度,并根据心率、平均动脉压调整瑞芬太尼靶控浓度。记录患者术中的心率、平均动脉压、脑电双频指数及术后疼痛评分。结果:2组患者各时间点的心率、平均动脉压和脑电双频指数差异均无统计学意义(P>0.05);试验组瑞芬太尼用量显著少于对照组(P<0.01);试验组在进入麻醉恢复室后5min时的疼痛评分显著高于对照组(P<0.05),2组进入麻醉恢复室后30 min及术后24 h疼痛评分的差异均无统计学意义(P>0.05)。结论:低剂量艾司洛尔的持续输注可显著减少全凭静脉麻醉中瑞芬太尼的用量。

Objective：To explore the influence of esmolol on the dosing of remifentanil in total intravenous anesthesia（TIVA）.Methods：A total of 40 female patients scheduled for thyroid surgery were randomly divided into 2 groups,with 20 patients in each group.The patients in the study group received a loading dose of esmolol through continuous intravenous infusion after tracheal intubation.The infusion was stopped after extubation.The control group received the same volume of 0.9%sodium Chloride.The target concentration of propofol was adjusted by bispectral index,and the target concentration of remifentanil was adjusted by heart rate and mean artery pressure.Intraoperative heart rate,mean artery pressure and bispectral index,as well as postoperative pain scores,were recorded.Results：There was no significant difference in heart rate,mean artery pressure and bispectral index between the two groups（P〉0.05）.The dosage of remifentanil in the study group was lower than that in the control group（P〈0.01）.The pain score was higher in the study group at 5 min after entering postanesthetic care unit（PACU）than that in the control group（P〈0.05）.There was no statistical significance in pain scores at 30 min after entering PACU and at 24 h after surgery（P〈0.05）between the two groups.Conclusions：Continuous low dosage infusion of esmolol could significantly decrease the consumption of remifentanil in TIVA.