纳布啡对插入喉罩时最低丙泊酚有效血浆质量浓度的影响

Effect of nalbuphine on the minimum effective plasma concentration of propofol during insertion of laryngeal mask occupation

目的对比不同剂量的纳布啡是否影响全麻诱导过程中喉罩插入时最低丙泊酚有效血浆质量浓度(C_(p50))。方法纳入美国麻醉医师协会(ASA)Ⅰ~Ⅱ级择期日间手术的病人89例,随机分为4组。P组:丙泊酚与氯化钠注射液(n=25);R组:丙泊酚与2ng·mL^(-1)瑞芬太尼(n=22);N_(1)组:丙泊酚与0.15mg·kg^(-1)纳布啡(n=22);N_(2)组:丙泊酚与0.2mg·kg^(-1)纳布啡(n=20),所有病人均采用靶控输注。当丙泊酚的血药质量浓度和效应室质量浓度处于平衡后将喉罩插入。采用改良的Dixon上下交叉序贯方式,根据喉罩插入过程中病人是否出现体动调整靶控丙泊酚的质量浓度,计算各组丙泊酚C_(p50)值。记录麻醉诱导前(t)、喉罩插入前(t_(1))、喉罩插入时(t_(2))和喉罩插入后3min(t_(3))时各组的平均动脉压(MAP)、心率(HR)和脑电双频指数(BIS)值。结果麻醉诱导前4组病人的HR、MAP和BIS值比较差异均无统计学意义(P>0.05)。喉罩插入前,R组HR较其他3组下降(P<0.05),P组MAP较其他3组下降(P<0.05),BIS值组间比较差异无统计学意义(P>0.05)。各组喉罩插入时和喉罩插入后3min的HR、MAP和BIS值比较差异均无统计学意义。和麻醉诱导前比较,各组病人喉罩插入后的HR、MAP和BIS值均明显下降(P<0.05)。P组C_(p50)值较其他3组更高(P<0.05),N_(2)组与R组比较差异无统计学意义(P>0.05)。结论纳布啡能有效降低喉罩插入时丙泊酚C_(p50)值,0.2mg·kg^(-1)的作用比0.15mg·kg^(-1)强,其效能和2ng·mL^(-1)瑞芬太尼血浆靶控质量浓度作用相当。

ObjectiveTo observe the effects of different doses of nalbuphine on the minimum effective plasma concentration of propofol(C_(p50))during the insertion of laryngeal mask airway(LMA)under general anesthesia.Methods89cases of ASA levelⅠ-Ⅱelective ambulatory surgery patients were divided into 4groups,group P:propofol and normal saline injection(n=25);group R:propofol and 2ng·mL^(-1) remifentanil(n=22);group N_(1):propofol and 0.15mg·kg^(-1) nalbuphine(n=22);group N_(2):propofol and 0.2mg·kg^(-1) nalbuphine(n=20).The target-controlled infusion was used in all patients.When the plasma concentration of propofol reached the equilibrium concentration in the effect-site,the LMA was inserted.The target-controlled concentration of propofol was adjusted according to the fact whether the patient had body movement or not when inserting the LMA with the improved Dixon upper and lower cross sequential method.Then the propofol C_(p50) values of each group were calculated.The mean arterial pressure(MAP),heart rate(HR)and bis-frequency index(BIS)of each group were recorded before anesthesia induction(t),before LMA insertion(t_(1)),at LMA insertion(t_(2)),and 3minutes after LMA insertion(t_(3)).ResultsThere was no significant difference in HR,MAP and BIS values among the groups before anesthesia induction,during the insertion of the LMA and 3 minutes after insertion(P>0.05).Before LMA insertion,the HR in group R was lower than in the other 3groups(P<0.05),MAP in group P was lower than in the other 3groups(P<0.05),and BIS group had no significant difference(P>0.05).Compared with before anesthesia induction,the values of HR,MAP and BIS after LMA insertion in each group were significantly decreased(P<0.05).The C_(p50) value of group P was higher than other 3groups(P<0.05),and group N_(2) was similar to group R(P>0.05).ConclusionNalbuphine can effectively reduce propofol C_(p50) when inserted into LMA,and the effect of 0.2mg·kg^(-1) was stronger than that of 0.15mg·kg^(-1).The efficacy of 0.2mg·kg^(-1) nalbuphine was comparable to that of 2ng·ml^(-1) remifentanil.