摘要
目的探讨瑞芬太尼、丙泊酚静脉复合全麻维持中不同瑞芬太尼、丙泊酚配伍剂量与麻醉效果的关系。方法择期手术接受全麻患者180例。诱导:2台注射泵同时泵注依托咪酯0.3 mg/kg、瑞芬太尼15μg/kg,时间6min,泵注1 min时静注阿托品0.007 mg/kg,意识消失后静注维库溴胺0.1 mg/kg,泵注结束后气管插管。维持:依丙泊酚全麻维持用量不同分为8组,丙泊酚泵速分别为10 mg/(kg·h)(B10组)、8 mg/(kg·h)(B8组)、7 mg/(kg·h)(B7组)、6 mg/(kg·h)(B6组)、5 mg/(kg·h)(B5组)、4 mg/(kg·h)(B4组)、3 mg/(kg·h)(B3组)、0 mg/(kg·h)(B0组);各组均予瑞芬太尼起始泵速60μg/(kg·h),调节瑞芬太尼泵速至MAP较其基础值下降5%左右维持至手术结束停药。结果①全麻维持使用不同剂量丙泊酚,调节瑞芬太尼用量均能达到MAP较基础值下降5%左右的效果;单用瑞芬太尼2.5μg/(kg·min)维持,反应熵平均为47.58,MAP比基础值升高8.14%,HR降低3.04%,平均4.57min清醒;瑞芬太尼增强丙泊酚的降压及降心率作用,随丙泊酚用量增加降压作用加强;达到相同降压作用,丙泊酚用量逐组增加时瑞芬太尼用量逐组减少,睁眼时间逐组延长,反应熵各组间比较无显著性差异。②全麻维持效果评级B4和B5组达Ⅰ级,B6、B7、B8组达Ⅱ级,B3组达Ⅲ级,B0、B10组达Ⅳ级。结论丙泊酚4或5 mg/(kg·h)配伍瑞芬太尼平均泵速45μg/(kg·h)是本研究人群最佳的全麻维持量效关系。
Objective It is to explore the relationship between anesthesia effect and different dose combination of remifentanil and propofol in compound intravenous anesthesia maintained by remifentanil and propofol.Methods 180 cases of patients undergoing selective operation and total anesthesia were selected.Induction：0.3 mg/kg etomidate,15 μg/kg remifentanil were injected by 2 injection pumps at the same time for 6min,in one min later,0.007 mg/kg atropine was given by iv,0.1 mg/kg vecuronium bromide was given by iv after consciousness lost,intubation was performed on at the end of lump injection.Maintaining：the patients were divided into 8 groups according to the maintained dosage of propofol,the lump speed were 10 mg/（kg· h）（B10 group）,8 mg/（kg· h）（B8 group）,7 mg/（kg· h）（B7 group）,6 mg/（kg· h）（B6group）,5 mg/（kg·h） （B5 group）,4 mg/（kg · h） （B4 group）,3 mg/（kg · h） （B3 group）,0 mg/（kg · h） （B0 group）,each group was given remifentanil 60 μg/（kg · h） at the beginning by lump injection,then the lump speed was regulated until MAP decreased 5% compared with its basic value.Results Regulation of remifentanil could lead to MAP decreased 5% compared with its basic value in total compound intravenous anesthesia with different dose of propofol.When simply maintaining with 2.5 μg/（kg ·min） remifentanil,the average reaction entropy was 47.58,MAP increased 8.14%,HR decreased 3.04% compared with the basic values,average wake time was 4.57 min,remifentanil could strengthen the effects of lowing down BP and HR of propofol with a dose dependence.When getting to the same BP,the dose of propofol increased and that of remifentanil decreased gradually in every group with a longer awake time.There was no significant difference in reaction entropy.The total anesthesia maintained effects showed that group B4 and B5 reached I degree,B6 and B7,B8 reached Ⅱ degree,B3 reached Ⅲ degree,B0 and B10 reached Ⅳ degree.Conclusion Propofol 4 or 5 mg/（kg · h） combined with remifentanil at the average lump injection speed of 45 μg/（kg · h） is the best dose-effect relationship of total anesthesia maintaining for this study population.
出处
《现代中西医结合杂志》
CAS
2014年第7期693-695,698,共4页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
深圳市宝安区科技创新局2012年科研立项资助项目(2012052)
关键词
瑞芬太尼
丙泊酚
维持麻
量效关系
remifentanil
propofol
anesthesia maintaining
dose-effect relationship
