靶控输注舒芬太尼复合全麻对围术期应激反应的影响

Effects of Target-controlled Infusion of Sufentanil on Perioperative Stress Response in Combined General Anesthesia

目的比较靶控输注(target-controlled infusion,TCI)舒芬太尼效应室靶浓度0. 10 ng/ml与0. 25 ng/ml复合七氟烷全麻对围术期应激反应的影响。方法 2015年9～12月择期全麻下腹腔镜手术40例(18～68岁,ASAⅠ或Ⅱ级),随机(信封法)分为2组,每组20例,麻醉诱导后舒芬太尼效应室靶浓度Ⅰ组为0. 10 ng/ml,Ⅱ组为0. 25 ng/ml。麻醉诱导采用舒芬太尼TCI、丙泊酚TCI和罗库溴铵静脉注射。麻醉维持采用舒芬太尼TCI复合吸入七氟烷,间断静脉注射罗库溴铵维持肌肉松弛。2组均采用效应室靶浓度TCI和脑电双频指数(bispectral index,BIS)监测指导和调控麻醉深度。每组随机选取10例经桡动脉取血,测定麻醉诱导前(基础值)、气腹后20 min和气管拔管后20 min血肾上腺素、去甲肾上腺素、多巴胺、皮质醇、血糖浓度和血气分析。结果气腹后20 min和气管拔管后20 min,Ⅱ组血皮质醇浓度明显低于Ⅰ组[气腹后20 min:中位数9. 85(6. 60～24. 50)μg/dl vs. 17. 85(6. 20～25. 50)μg/dl,Z=-2. 343,P=0. 019;气管拔管后20 min:10. 00(4. 90～20. 30)μg/dl vs. 28. 40(9. 30～34. 80)μg/dl,Z=-3. 175,P=0. 001]。2组血肾上腺素、去甲肾上腺素、多巴胺、血糖浓度和血气分析差异无统计学意义(P> 0. 05)。结论复合七氟烷全麻时,舒芬太尼TCI效应室靶浓度0. 25 ng/ml较0. 10 ng/ml抑制围术期应激反应的效果更好。

Objective To compare the effects on perioperative stress response of target-controlled infusion (TCI) of sufentanil with target effect-site concentration 0.10 ng/ml and 0.25 ng/ml when combined with sevoflurane in general anesthesia.Methods Forty patients with American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ,aged 18-68 years old,scheduled for selective laparoscopic surgery under general anesthesia from September to December 2015,were included in this study.The patients were randomly divided into two groups with 20 patients in each group by envelope method:after induction of anesthesia,target effect-site concentration of sufentanil was set randomly at 0.10 ng/ml (Group Ⅰ) or 0.25 ng/ml (Group Ⅱ),respectively.Anesthesia was induced with sufentanil TCI combined with propofol TCI and intravenous injection of rocuronium.Anesthesia was maintained with sufentanil TCI combined with inhalation of sevoflurane and intermittent intravenous boluses of rocuronium as needed to maintain muscle relaxation.The depth of anesthesia was guided and controlled according to the target effect-site concentration of TCI and bispectral index (BIS) monitoring in the two groups.Arterial blood samples were gathered in 10 patients randomly selected from each group for determination of blood epinephrine,norepinephrine,dopamine,cortisol,blood glucose concentrations and blood gas analysis at the time points of before induction of anesthesia (baseline),20 min after pneumoperitoneum,and 20 min after tracheal extubation.Results The median blood cortisol concentrations in the Group Ⅱ were lower at the time point of 20 min after pneumoperitoneum [9.85 (6.60-24.50)μg/dl vs.17.85 (6.20-25.50)μg/dl,Z =-2.343,P =0.019] and 20 min after tracheal extubation [10.00 (4.90-20.30)μg/dl vs.28.40 (9.30-34.80)μg/dl,Z =-3.175,P =0.001] than those in the Group Ⅰ,respectively.There were no significant differences in values of blood epinephrine,norepinephrine,dopamine,blood glucose concentration and blood gas analysis between the two groups (P >0.05).Conclusion TCI sufentanil with target effect-site concentration 0.25 ng/ml is better than 0.10 ng/ml when combined with sevoflurane in suppressing perioperative stress response.