摘要
目的比较不同血浆靶控浓度输注瑞芬太尼在高血压病人全麻诱导中的应用。方法高血压与非高血压病人各 4 0例 ,均随机分为 4组 (n =10 )。分别设定瑞芬太尼血浆靶控浓度为 1、2、3、4ng/mL ,5min后开始靶控输注异丙酚 ,血浆浓度为2 .5 μg/mL ,10min后给予维库溴铵 0 .1mg/kg ,2min后进行气管插管。在各时点记录血压、心率、Grant气管插管评分、SpO2 、BIS值及诱导期间使用的辅助药物及不良反应。结果高血压组相对于同浓度非高血压组阿托品的使用例数增多 ,各浓度的瑞芬太尼引起血压的变化及BIS值均无统计学差异。插管条件评分 ,瑞芬太尼 2、3、4ng/mL组间无统计学差异 ,但均明显优于 1ng/mL组。相对于插管前即刻 ,插管后与切皮时刻 ,各组血压均有上升 ,3、4ng/mL组血压与心率上升幅度较小。结论使用TCI方法输注瑞芬太尼与异丙酚在高血压病人进行全麻诱导 ,两者靶控浓度分别为 3ng/mL与 2 .5
Objective To study the changes of hemodynanics and reaction of intubation in hypertension patients with plasma target controlled infusion of remifentanil during induction of general anesthesia. Methods Forty patients with hypertension and forty in normal BP undergoing elective abdominal surgery with ASA I～II were randomized into 4 groups (n=10) and given remifentanil with target concentration 1, 2, 3, 4 ng/mL respectively. Scoplamine 0.01 mg/kg intramuscular injected 60 min before infusion. After entering operation room, central vein was cathetered for remifentanil and peripheral vein for propofol with target controlled concentration 2.5 μg/mL which start after remifentanil infusion for 5 min, 10 min later, 0.1 mg/kg vecuronium was infused within 5 s and intubation was carried out 2 min after that. BP, HR, BIS, SpO 2, intubation score(following Grant's method) and all side effects and adjuvant drugs were recorded at six time points-before anesthesia, 5 min after remifentanil infusion, 10 min after propofol infusion, 2 min after vecuronium infusion, 1 min after finishing intubation, 2 min after incision. Results Hypertensive patients were of more significant changes of hemodynamics and required more atropine compared to non-hypertensive group with the same remifentanil concentration, especially in 4 ng/mL remifentanil group. But BP changes caused by remifentanil were of no statistical difference. BIS values after infusion of remifentanil were of no statistical difference comparing to the baseline. The intubation condition were satisfied in three higher remifentanil concentration groups. And 3,4 ng/mL group after intubation and after incision were of less BP and HR changes compared to pre-intubation. Conclusion When total intravenous anesthesia with target controlled infusion of remifentanil and propofol are used in hypertensive patients, the target concentration of these two drugs could be 3 ng/mL and 2.5 μg/mL respectively, which will keep the hemodynamics steady.
出处
《上海第二医科大学学报》
CSCD
2004年第11期945-948,954,共5页
Acta Universitatis Medicinalis Secondae Shanghai
关键词
瑞芬太尼
二异丙酚
靶控输注
静脉麻醉
remifentanil
propofol
target controlled infusion
intravenous anesthesia
