不同靶控浓度舒芬太尼对七氟醚MACBAR的影响.doc

不同靶控浓度舒芬太尼对七氟醚MACBAR的影响 The effects of different target-controlled concentrations of sufentanil on MACBAR of sevoflurane in patients during abdominal surgery 卫生部北京医院麻醉科 100730 黄舜 左明章 中文摘要 目的 观察不同靶控浓度舒芬太尼对七氟醚抑制外科切皮后交感反应MAC值的影响，探求联合应用时适宜的配伍剂量。方法 择期腹部手术患者80例，ASAⅠ～Ⅱ级，年龄20～60岁，随机分为4组（n=20）：不用舒芬太尼组（S0组），舒芬太尼靶浓度0.12 ng/ml组（S1组）、舒芬太尼靶浓度0.18ng/ml组（S2组）、舒芬太尼靶浓度0.24ng/ml组（S3组）。4组均靶控输注丙泊酚（Ce3.5μg/ml）和雷米芬太尼（4ng/ml）行麻醉诱导，待意识消失静注罗库溴胺（0.6mg/kg），气管插管后立即停用丙泊酚和雷米芬太尼，吸入七氟醚和60%笑气。各组初始呼气末七氟醚浓度分别为3.0%、1.8%、1.3%和1.1%。S0组气管插管后不给予舒芬太尼输入，其余组各自设定至目标靶浓度。采用序贯法根据手术切皮时患者HR和MAP的变化测定每组的七氟醚MACBAR。结果 S0组MACBAR为2.3%[2.0～2.5%]，S1组MACBAR为1.6%[1.4～1.7%]，S2组MACBAR为1.1%[0.9～1.3%]，S3组MACBAR为0.9%[0.8～1.1%]，4组间比较有统计学差异（P0.05）。结论 靶浓度0.12 ng/ml、0.18ng/ml和0.24ng/ml的舒芬太尼可分别降低腹部手术患者七氟醚MACBAR30%、52%和61%。 关键词：七氟醚; 舒芬太尼; 抑制交感反应的最小肺泡浓度; 封顶效应 英文摘要 English Abstract Objective To investigate the effects of three different target-controlled plasma concentrations of sufentanil on the sevoflurane requirement for blunting sympathetic responses after surgical incision (MACBAR), searching the optimum doses as combined application. Method 80 ASAⅠ～Ⅱpatients aged 20-60yr, undergoing elective abdominal surgery were randomly divided into 4 groups（n=20 each）:control group（S0）and 3 sufentanil groups （S1, S2, S3）.The patients were unpremedicated. Anesthesia was induced with TCI of propofol（Ce3.5μg/ml）and remifentanil（Ce4ng/ml）.Tracheal intubation was facilitated with rocuronium（0.6mg/kg）. Then the propofol and remifentanil were immediately stopped and the lungs were ventilated with sevoflurane and a mixture of 60% nitrous oxide. We arbitrarily started in each group with an end-tidal concentration of sevoflurane of 3%、1.8%、1.3% and 1.1%. After intubation TCI sufentanil was started , the Ce of S1、 S2、S3 group were 0.12 ng/ml、0.18 ng/ml and 0.24 ng/ml respectively. According to the patients’ response to skin incision described by HR/MAP change，we measured the sevoflurane MACBAR for each group by up-and-down method. Results Th