丙泊酚与舒芬太尼相互作用的药效学关系分析

Pharmacodynamic relationship analysis of the interaction between Propofol and Sufentanil

目的探讨丙泊酚与舒芬太尼相互作用的药效学关系。方法 66例全身麻醉进行腹部手术患者,所有患者均靶控注射丙泊酚与舒芬太尼进行全身麻醉。按照舒芬太尼浓度不同将患者分为A组、B组、C组,每组22例。A组舒芬太尼浓度为0.3 mg/ml, B组舒芬太尼浓度为0.5 mg/ml, C组舒芬太尼浓度为3.0 mg/ml。当三组患者的效应室药物浓度与患者的血浆药物浓度达到平衡时,按序贯法注入丙泊酚。比较三组患者丙泊酚最大效应浓度,气管插管时的心率(HR)、血压(BP)、平均动脉压(MAP)、舒张压(DBP),入室时、药物平衡时、意识消失时、气管插管时BIS值。结果 C组丙泊酚最大效应浓度均低于A组、B组,差异有统计学意义(P<0.05)。气管插管时, A组HR、SBP、MAP、DBP均高于C组;B组HR高于C组, SBP、MAP、DBP低于C组,差异有统计学意义(P<0.05)。药物平衡时, B组BIS值较入室时出现明显下降,且B组低于A组、C组,差异有统计学意义(P<0.05)。意识消失时、气管插管时,三组患者BIS值均较入室时、药物平衡时均出现明显下降趋势,差异有统计学意义(P<0.05);但三组患者BIS值比较差异无统计学意义(P>0.05)。结论舒芬太尼和丙泊酚之间具有更强的协同作用,在具体的临床用药中,以舒芬太尼用量在0.5 mg/ml此基础上调整丙泊酚至有效剂量,临床效果最佳。

Objective To investigate and analyze the pharmacodynamic relationship of interaction between the Propofol and Sufentanil. Methods A total of 66 patients with abdominal surgery under general anesthesia were selected, all patients were given general anesthesia with target controlled infusion of Propofol and Sufentanil. They were divided into group A, group B and group C according to the different concentrations of Sufentanil, 22 cases in each group. The Sufentanil concentration of group A was 0.3 mg/ml, Sufentanil concentration of group B was 0.5 mg/ml, and Sufentanil concentration of group C was 3.0 mg/ml. When the effusive chamber drug concentration of the three groups was balanced with the plasma drug concentration of the patients, Propofol was injected according to the sequential method. The maximum effect of Propofol concentration, the heart rate（HR）, blood pressure（BP）, mean arterial pressure（MAP） and diastolic blood pressure（DBP） during endotracheal intubation, the BIS values when entering the room, drug balance, loss of consciousness and endotracheal intubation among the three groups were compared. Results The maximum effect of Propofol concentration in the group C was significantly lower than those in the group A and group B（P〈0.05）. During endotracheal intubation, the HR, SBP, MAP and DBP of group A were significantly higher than those of the group C, while the HR of the group B was significantly higher than that of group C, and the SBP, MAP and DBP of the group B were significantly lower than those of group C（P〈0.05）. When drug balance, the BIS value of group B was significantly lower than that when entering the room, and the BIS valus of the group B was significantly lower than those of group A and group C（P〈0.05）. When loss of consciousness and endotracheal intubation, the BIS values of the three groups were significantly lower than those when entering the room and the drug balance（P〈0.05）. But there was no significant difference in the BIS value among the three groups（P〉0.05）. Conclusion Sufentanil and Propofol have a stronger synergistic effect. In the specific clinical use of Sufentanil dosage of 0.5 mg/ml on the basis of adjusting Propofol to the effective dose, the clinical effect is the best.