[1]郑清,蒋建渝.不同血浆浓度瑞芬太尼复合异氟烷麻醉的药效学随机对照研究[J].中国微创外科杂志,2006,06(2):132-136.
　Zheng Qing,Jiang Jianyu..Combined anesthesia with isoflurane and different doses of rem ifentani:l A study of pharmacodynam ics[J].Chinese Journal of Minimally Invasive Surgery,2006,06(2):132-136.
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不同血浆浓度瑞芬太尼复合异氟烷麻醉的药效学随机对照研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
06
期数:
2006年2期
页码:
132-136
栏目:
出版日期:
2006-02-20

文章信息/Info

Title:
Combined anesthesia with isoflurane and different doses of rem ifentani:l A study of pharmacodynam ics　
作者:
郑清; 蒋建渝　
北京大学第三医院麻醉科,北京,100083
Author(s):
Zheng Qing;  Jiang Jianyu.
Department of Anesthesiology, Peking University Third Hospital, Beijing 100083, China
关键词:
瑞芬太尼; 丙泊酚; 麻醉深度; 异氟烷
Keywords:
Remifentani; l　Propofo; l　Depth of anesthesia; 　Isoflurane
分类号:
R614.2
文献标志码:
A
摘要:
目的观察瑞芬太尼、异氟烷不同配伍方式静吸复合全麻在腹腔镜手术中应用的药效学.方法选择ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除术或腹腔镜卵巢囊肿切除术45例随机分为3组,每组15例.3组诱导方式均相同.麻醉维持,A组维持吸入异氟烷1.3肺泡气最低有效浓度值(minimum alveolar concentration,MAC);B组维持吸入异氟烷0.6 MAC复合瑞芬太尼血浆靶浓度4 ng/L靶控输注;C组维持吸入异氟烷0.4 MAC复合瑞芬太尼血浆靶浓度6 ng/L靶控输注.药效学观察指标:脑电双频指数(bispectral index,BIS)、心率变异性(heart rate variability,HRV)、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)及追加肌松剂时间、呼吸恢复时间、睁眼时间、气管导管拔管时间、定向力恢复时间、术后"术中知晓"随访.同时记录各组维持期吸入异氟烷的肺泡MAC.药效学观察指标进行组间比较.结果①A组BIS值气腹2 min 和胆囊或卵巢肿物切下时均较B、C组低,但HRV数值在气腹2 min和胆囊或卵巢肿物切下时均较B、C组高;A组MAP、HR在气腹2 min时高于C组,但拔管后和清醒时又较C组低.②吸入异氟烷0.6 MAC伍用瑞芬太尼血浆靶浓度4 ng/L,及吸入异氟烷0.4 MAC伍用瑞芬太尼血浆靶浓度6 ng/L在腹腔镜手术中即可维持一定麻醉深度.③在拔管时间、睁眼时间、定向力恢复时间上,B、C组均较A组有明显缩短.结论吸入异氟烷0.6 MAC伍用瑞芬太尼血浆靶浓度4 ng/L,及吸入异氟烷0.4 MAC伍用瑞芬太尼血浆靶浓度6 ng/L麻醉应用于腹腔镜手术,既可保证术中不同刺激的麻醉深度,又可使患者术毕快速高质量清醒.瑞芬太尼4 ng/L复合异氟烷0.6 MAC临床应用较瑞芬太尼6 ng/L复合异氟烷0.4 MAC更为理想.
Abstract:
Objective　To study pharmacodynamic changes of combined anesthesiawith remifentanil atdifferent targetplasma concentrations and isoflurane atdifferentminimal alveolar concentrations (MAC) in laparoscopic operations.　M ethods　Forty-five patientswithASA statusⅠ~Ⅱ, receiving selective laparoscopic cholecystectomy or laparoscopic oophorocystectomy, were included. The patientswere randomly divided into three groupswith 15 patients in each group. In theGroupA, anesthesiawasmaintained with isoflurane inhalation at theMAC of1. 3; in theGroup B, anesthesiawasmaintainedwith both isoflurane inhalation at theMAC of0. 6 and remifentanil target-controlled infusion at4 ng/L; and in theGroup C, anesthesiawasmaintainedwith both isoflurane inhalation at theMAC of 0. 4 and remifentanil target-controlled infusion at 6 ng/L. Pharmacodynamic parameters and recovery characteristics, including bispectral index (BIS), heart rate variability (HRV), mean arterialpressure (MAP), heart rate (HR), time to additional administration ofmuscle relaxants, time to the recovery ofspontaneous breathing, time to eye opening, time to endotrachealextubation, time to the recovery of orientation, and follow-up survey of " awareness during operation", were compared among the 3 groups.　 Results　①The BIS value was lower in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladderor the ovarian cyst. Themeasures ofHRVwere higher in theGroupA than in theGroup B and C at the time of pneumoperitoneum for2 min and removal of the gallbladder or the ovarian cyst. Themeasures ofMAP andHR in theGroupA were higher than those in the Group C at the time of pneumoperitoneum for2 min, and were lower than those in theGroup C at the time of the endotracheal extubation and the recovery of consciousness.②Either isoflurane inhalation at the MAC of 0. 6 combined with remifentanil target-controlled infusion at4 ng/L or isoflurane inhalation at theMAC of0. 4 combinedwith remifentanil target-controlled infusion at 6 ng/L provided satisfactory anesthetic maintenance.③Significantly shorter time to endotracheal extubation, to eye opening, and to the recovery of orientationwere recorded in theGroup B and C than in theGroupA.　Conclusions　Anesthesiawith target-controlled infusion of remifentanil combinedwith inhalation of isoflurane can be used for laparoscopic surgery. Pharmarcodynamic parameters and recovery characteristics show that combined use of remifentanil infusion at4 ng/L and isoflurane inhalation at theMAC of0. 6 provides optimal anestheticmaintenance.

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更新日期/Last Update: 2014-01-27