09年会单纯靶控输注瑞芬太尼的安全性.docVIP

09年会-临床麻醉与研究 单纯靶控输注瑞芬太尼的安全性 作者单位：卫生部北京医院麻醉科 邮编：100730 作者姓名：彭文平 左明章 【摘要】 目的 观察单纯靶控输注瑞芬太尼的安全性。方法40例择期全麻手术患者，以血浆靶控方式输注瑞芬太尼，按不同的预计血浆浓度随机分为四组（R2、R4、R6和R8组）。在瑞芬太尼血浆和效应室浓度达平衡过程中，观察患者呼吸抑制情况、肌肉强直发生情况，记录副作用发生时瑞芬太尼的预计效应室药物浓度。记录瑞芬太尼达平衡时患者的SBP、DBP、MAP和HR。结果 在瑞芬太尼达平衡过程中，R6组和R8组共有17例患者出现呼吸抑制，呼吸抑制时的瑞芬太尼预计效应室药物浓度为6.1±1.0ng/ml；R8组有3例患者出现中度的肌肉强直，发生时瑞芬太尼预计效应室药物浓度平均为7.5ng/ml，所有患者均未出现重度肌肉强直；达平衡过程中，血流动力学指标无明显改变。 结论 单纯靶控输注瑞芬太尼时，预计血浆浓度小于4ng/ml是安全的，浓度大于4ng/ml后，呼吸抑制和肌肉强直发生率增加，但对血流动力学的影响不大。 　　【关键词】瑞芬太尼；靶控输注；安全性；呼吸抑制；肌肉强直 The safety of remifentanil alone by target-controlled infusion Peng Wen-ping, Zuo Ming-zhang. Department of Anesthesiology, Beijing Hospital, Beijing 100730, China 【Abstract】 Objective To examine the safety of remifentanil alone by target-controlled infusion(TCI). Methods Forty patients undergoing elective surgery under general anesthesia were enrolled in this study. The patients were randomized to receive remifentanil at a predicted target plasma concentration of 2 ng/ml, 4 ng/ml, 6 ng/ml or 8 ng/ml (group R2, R4, R6, R8). During the process of equilibration between plasma and effect site concentration of remifentanil, respiratory depression and muscle rigidity were recorded. And the effect-site concentrations of remifentanil were recorded when the side effects occurred. The following parameters were recorded at equilibration: systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure (MAP), heart rate(HR). Results During the process of equilibration, there were 17 patients suffering from respiratory depression at group R6 and R8, and the effect-site concentrations of remifentanil was 6.1±1.0ng/ml at respiratory depression. There were 3 patients suffering from moderate muscle rigidity at group R8, and the effect-site concentrations of remifentanil was 7.5ng/ml at muscle rigidity. No severe muscle rigidity occoured. Hemodynamics did not change significantly during equilibration. Conclusion It is safe when