不同血浆靶浓度舒芬太尼对腹腔镜气腹刺激时七氟醚MACBAR的影响

Effects of different target-controlled concentrations of sufentanil on MAC BAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus

目的观察不同血浆靶浓度舒芬太尼对腹腔镜手术患者气腹刺激时抑制50%患者交感肾上腺素能反应的七氟醚最低肺泡有效浓度(MAC BAR)的影响。方法选择行腹腔镜胆囊切除术的患者125例,性别不限,年龄30~65岁,ASAⅠ或Ⅱ级,随机分为S0、S1、S2、S3、S4共五组,舒芬太尼血浆靶浓度分别为0、0.1、0.3、0.5、0.7 ng/ml。吸入七氟醚麻醉诱导,意识消失后,静脉注射罗库溴铵0.6 mg/kg完成喉罩置入,调节呼气末七氟醚浓度,靶控舒芬太尼,待呼气末七氟醚浓度达预设值并稳定15 min以上,建立气腹。采用序贯法测定5组七氟醚MAC BAR值,同时测定患者气腹前后肾上腺素、去甲肾上腺素浓度。结果当静脉靶控输注0、0.1、0.3、0.5及0.7 ng/ml的舒芬太尼时,S0、S1、S2、S3和S4组七氟醚MAC BAR值分别为(5.33±0.13)%、(4.53±0.08)%、(2.86±0.15)%、(2.23±0.10)%和(2.13±0.08)%。五组气腹刺激前后肾上腺素、去甲肾上腺素浓度差异无统计学意义。结论腹腔镜气腹刺激时七氟醚MAC BAR随舒芬太尼血浆靶浓度的增加而降低,当舒芬太尼血浆靶浓度超过0.5 ng/ml时,七氟醚MAC BAR值的下降出现封顶效应。当患者交感肾上腺素能反应被抑制时,血中肾上腺素、去甲肾上腺素浓度变化不受舒芬太尼血浆靶浓度的影响。

Objective To observe the effects of different target plasma sufentanil concentrations on the minimum alveolar concentration(MAC)of sevoflurane for blocking adrenergicresponse(BAR)(MAC BAR)in patients undergoing laporoscopic surgery with CO 2 pneumoperitoneum stimulation.Methods One hundred and twenty five patients undergoing laparoscopic cholecystectomy,regardless of gender,aged 18-65 years,falling into ASA physical statusⅠorⅡcategory,were enrolled in this study.All the patients were randomly divided into 5 groups(S0,S1,S2,S3 and S4)with different sufentanil plasma target concentrations(0,0.1,0.3,0.5 and 0.7 ng/ml).Anaesthesia was induced by multiple deep inhalation breaths of 8%sevoflurane in 100%oxygen till the patients were adequately clinically sedated,then 0.6 mg/kg of rocuronium was injected to facilitate the insertion of laryngeal mask airway.Sevoflurane and sufentanil were administered by the respective preset concentration in each group.The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentrations had been maintained stable at least for 15 min.The MAC BAR of sevoflurane was measured by the sequential method.Meanwhile,epinephrine and norepinephrine concentrations were also determined before and after pneumoperitoneum stimulus.Results The base value of sevoflurane MAC BAR in group S0,S1,S2,S3 and S4 were(5.33±0.13)%,(4.53±0.08)%,(2.86±0.15)%,(2.23±0.10)%and(2.13±0.08)%when 0,0.1,0.3,0.5 and 0.7 ng/ml of sufentanil target controlled plasma concentration was used,respectively.But the decreased degree of sevoflurane MAC BAR had no significant difference between the two groups of 0.5 ng/ml and 0.7 ng/ml of sufentanil plasma concentrations.No significant difference was found in the concentration of epinephrine or norepinephrine between before and after pneumoperitoneum stimulation in each group.Conclusion Increasing sufentanil plasma target controlled concentration can decrease the MAC BAR of sevoflurane.Celling effect of the decrease of sevoflurane’s MAC BAR can occur when the sufentanil target-controlled concentration was higher than 0.5 ng/ml.When the sympathetic adrenergic response was suppressed in half of the patients in each group,the changes in plasma target concentration of sufentanil.