丙泊酚靶控输注复合右美托咪定对肿瘤患者麻醉影响的比较

Comparison of effects of propofol target controlled infusion combined with dexamethymidine on anesthesia in tumor patients

目的比较丙泊酚靶控输注Marsh和Schnider模型复合右美托咪定对肿瘤患者麻醉诱导的影响。方法选择首都医科大学附属北京世纪坛医院结直肠癌择期全麻下行常规细胞减灭术和腹腔热灌注化疗患者60例。随机分为两组:Marsh模型组(M组,n=30)和Schnider模型组(S组,n=30)。所有患者均给予右美托咪定0.8ug/kg负荷剂量和靶控输注瑞芬太尼2ng/ml。待瑞芬太尼达到目标效应室浓度后,M组和S组分别采用丙泊酚靶控输注系统Marsh模型目标血浆浓度2ug/ml和Schnider模型目标效应室浓度2ug/ml进行麻醉的诱导。若诱导在3分钟后未成功,Ct每30秒增加0.5ug/ml直到成功诱导。记录诱导成功的目标靶控浓度、效应室浓度、诱导所需时间和当时的血流动力学参数。结果应用Schnider模型成功诱导所需目标靶控浓度要低于Marsh模型(3.43±0.22vs4.06±0.29μg/ml;P=0.05),可做进一步大样本的研究讨论。与Marsh模型相比,Schnider模型的诱导时间也较短(128.3±5.31vs160.7±3.30;P=0.01),但诱导成功后血流动力学参数均无太大变化。结论两组比较中,右美托咪定降低了Schnider模型的诱导所需的目标靶控浓度,缩短了诱导时间。

Objective Compared with the effects of Dexmedetomidine on the induction of anaesthesia using Marsh and Schnider models of propofol Target-controlled Infusion.Methods 60 patients with colorectal cancer scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy under general anesthesia were randomly divided into 2 groups:Marsh group(group M,n=30)and Schnider group(group S,n=30).All the patients received 0.8μg/kg loading dose of dexmedetomidine,followed by TCI anaesthesia with remifentanil at 2 ng/mL.After the effect-site concentration of remifentanil reached 2 ng/mL,propofol TCI induction was started.Anaesthesia induction commenced in the Marsh group at a target plasma concentration of 2μg/mL,whereas it started in the Schnider group at a target effect-site concentration of 2μg/mL.If induction was delayed after 3 min,the target concentration was gradually increased to 0.5μg/mL every 30 sec until successful induction.The Ct at successful induction,Ce at successful induction,induction time,and haemodynamic parameters were recorded.Results The requirement of Ct for successful induction by Schnider model was significantly lower than that of Marsh model(3.43±0.22 VS 4.06±0.29μg/ml;P=0.05).Compared with Marsh model,the induction time of Schnider model was shorter(128.3±5.31 vs 160.7±3.30;P=0.01),and there was no significant change in hemodynamic parameters after successful induction.Conclusions In the inter-group comparison,dexmedetomidine reduced the Ct concentration required for induction of Schnider model and shortened the induction time.