中青年择期手术实施瑞芬太尼、丙泊酚静脉复合全麻中3种控制性降压幅度与瑞芬太尼用量的关系

Relationship between remifentanil dosages used in young and middle-aged patients with selective operation undergoing compound intravenous anesthesia maintained by remifentanil and propofol and 3 different controlled degree of anti-hypertension

目的观察中青年择期手术患者实施瑞芬太尼、丙泊酚静脉复合全麻维持中3种控制性降压幅度与瑞芬太尼用量的关系。方法选择择期手术接受全麻的中青年患者61例,随机分为A、B、C 3组,全麻维持中A组20例维持MAP比其基础MAP降低〉5%～10%组,B组21例降低〉10%～15%组,C组20例降低〉15%～20%。全麻维持中泵注丙泊酚6mg/（kg·h）恒速不变,调节瑞芬太尼用量[起始泵速60μg/（kg·h）],在手术开始后15 min内把维持MAP降低到各组的要求范围并持续到手术结束前5 min停止用药。结果 3组全麻诱导前MAP均比其基础MAP升高15%以上,组间比较差异无统计学意义。在固定丙泊酚6 mg/（kg·h）时,3组全麻维持中维持MAP比其基础MAP降低幅度均在预计范围内,均达到各自的降压要求范围。降压达标维持瑞芬太尼平均用量A组最少,C组最多,3组间比较差异均有统计学意义（P均〈0.05）。3组降压达标维持MAP平稳指数均小于其基础MAP平稳指数,组间比较差异均无统计学意义。3组全麻后睁眼时间、手术时间比较差异无统计学意义。降压超过其基础MAP 10%以上后部分患者出现降压封顶效应,再增加瑞芬太尼用量维持MAP不再继续降低,B组出现降压封顶效应率明显低于C组（P〈0.05）。结论全麻诱导前MAP均高于其基础MAP。全麻维持中与一个恒定丙泊酚用量配伍,瑞芬太尼用量越大血压降低幅度越大,降压幅度越大,部分患者会出现降压封顶效应,这时再增加瑞芬太尼用量维持MAP不再继续降低反而降低幅度开始减小。瑞芬太尼用量与控制性降压的幅度个体差异较大,出现降压封顶效应时瑞芬太尼用量个体差异也较大。

Objective It is to observe the relationship of 3 kinds of amplitude of blood pressure with the dosage of remifentanil in the middle and young patients undergoing elective surgery and received combined general anesthesia with remifentanil and propofol. Methods 61 young and middle-aged patients undergoing selective operation and general aesthesia were selected and divided randomly into three groups, in which the group with maintained average arterial pressure （short for AMP） decreased 〉5% -10% than its basic MAP as Group A（n =20）, which decreased 〉10% - 15% as Group B（n=21）, 〉 15% -20% as Group C （n = 20）. While maintaining general anesthesia, the syringe pumps with propofol in constant velocity of 6mg/ （kg· h） was arranged, by adjusting remifentanil dosage （initial pumping velocity as 60 g/ （kg·h）） to lower the maintained MAP value into the expected range of each group in 15 minutes after the beginning of operation, and keep such treatment till stopping the medication 5 minutes earlier before the operation ends. Results The MAP in the three group before induction of general anesthesia increased more than 15% compared with its basic MAP, there was no statistical difference in comparison among every group（P 〉 0.05）. With the constant 6mg/ （kg ·h） propofol dosage, the maintained MAP in the three group compared with its basic MAP were all up to the range of their blood pressure. The maintained average remifentanil dosage was the least in group A, less ni group B and the most in group C, the differences were significant among the three groups（ P all 〈0.05）. All the stationary indexes of maintained MAP in the three Group were smaller than its basic MAP stationary index, there was no statistical difference among these groups （ P 〉 0.05 ）. When the anti-hypertension degree was more than 10% compared with the basic MAP, there were ceiling effect of anti-hypertension in part of the patients, by increasing remifentanil dosage the maintained MAP was no longer decreased. The ceiling effects incidence of anti-hypertension in Group B was lower than that in Group C. Conclusion MAP before induction of general anesthesia is higher than its basic MAP. During maintenance of general anesthesia, with a constant propofol usage as concerted application, the more remifentanil dosage being used, the higher degree blood pressure decreased. With the higher degree of blood pressure decrease, there shall be the ceiling effects for anti-hypertension occurred in part of patients. At this time, the MAP is maintained by no longer being reduced further, but the magnitude is reduced by the start of the reduction, if again increasing the dose of remifentanil. There was a large difference between the dose of remifentanil used in each individual, after the capped effect of blood pressure was reduced has occurred.