胸科手术病人全凭静脉麻醉瑞芬太尼靶控输注浓度的剂量探讨.pdfVIP

· 论 看 · J Med Res，June 2008，Vo1．37 No．6 胸科手术病人全凭静脉麻醉瑞芬太尼靶控 输注浓度的剂量探讨 边 磊 陶德强 摘 要 目的 探讨胸科手术全凭静脉麻醉中瑞芬太尼的靶控输注浓度。方法 45例择期行胸科手术病人，ASA I～Ⅱ 级，年龄40～65岁，体重50～75kg。根据瑞芬太尼靶浓度不同随机分为3组：4nS／ml组(I组)，6ng／ml组(Ⅱ组)，8ng／ml组(Ⅲ 组)。麻醉诱导为分别TCI 3种不同靶浓度瑞芬太尼和3 g／ml的异丙酚，待病人意识消失后，静脉注射罗库溴铵0．6rag／kg，1min 后行气管插管。麻醉维持3组瑞芬太尼靶控浓度维持不变，调节异丙酚靶浓度维持脑电双频指数(Bm)在45～55之间，间断注 射罗库溴铵维持肌松。记录病人平卧 10min(T。)，麻醉诱导后气管插管前即刻(T。)，气管插管即刻(T：)，切皮后即刻(T，)，开胸 探查(T。)、缝皮(T )、拔管(T6)时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(fiR)、BIS值。并在以上时间点抽取 静脉血检测血浆肾上腺素(E)、去甲肾上腺素(NE)浓度。结果 I组病人的SBP、DBP、MAP、HR、NE、E浓度在气管插管即刻、 切皮后即刻、开胸探查、拔管时均明显升高(P0．05或0．01)，Ⅱ组、Ⅲ组各指标仅在拔管时高于基础值(P0．05)，Ⅲ组在插管 前血压、HR均较基础值明显下降(P0．05或0．01)。麻醉诱导后插管前的血压、HRⅢ组与I组比较差异有显著性(P0．05)， NE、E及HR在气管插管即刻、切皮后即刻、开胸探查时Ⅲ组与I组比较差异有显著性(P0．05)。结论 全凭静脉麻醉下胸科 手术病人靶控输注6ng／ml瑞芬太尼以联合3 g／ml的异丙酚较为适宜。 关键词 哌啶类 二异丙酚 药物释放系统 Target—controlled Infusions of Remifentanll and Propofol During Thoracic Surgery． Bian Lei，Tao Deqiang．Department of Anesthesiolo— gY，HangTian Hospital Affiliated of Beking University，BeUing 100046，China Abstract 0bjective To compare the effects of target—controlled infusion(TCI)of remifentanil in three different doses in thoracic patients undergoing total intravenous anesthesia．Methods Forty—five ASA I～II patients aged 40～60yr undergoing thoracic surgery were randomly divided into three groups．The patients were given midazolam 0．05mS／kg and artropine 0．5 mS／kg i．m．before anesthesia． Anesthesia was induced with remifentanil and propofol both given by TCI simultaneously．The target concentration of propofol was set at 3WS／ml and remifentanil at 4，6，8nS／ml(group I，Ⅱ，Ⅲ)．When the patients lost conscionsness，rocuronium 0．6mS／kg was given i．V．to facilitate intubation．Anesthesia was maintained with TCI of propofol—remifentanil and intermittent i．v．boluses of rocuronium．Remifen— tanil target concentration mai