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医药导报  2019, Vol. 38 Issue (6): 742-746    DOI: 10.3870/j.issn.1004-0781.2019.06.012
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不同剂量瑞芬太尼对丙泊酚靶控输注诱导期效应室浓度和麻醉深度的影响
刘龙娟(),孔重红()
铜川矿务局中心医院麻醉科,铜川 727000
Effect of Different Doses of Remifentanil on the Concentration of Effect Compartment and the Depth of Anesthesia in the Induction Period of Propofol Target Infusion
Longjuan LIU(),Zhonghong KONG()
Department of Anesthesiology,Central Hospital of Tongchuan Mining Bureau, Tongchuan 727000, China
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摘要 

目的 以脑电熵指数(M-Etronpy)为麻醉镇静深度指标,探讨两种剂量瑞芬太尼对丙泊酚靶控输注诱导期间效应室浓度和麻醉深度的影响。方法 需要全身麻醉的患者81例,根据瑞芬太尼的不同目标浓度分为A、B、C组(n=27)。A组接受0.9%氯化钠注射液用于麻醉诱导和维持,B组和C组分别采用2,4 ng·mL-1瑞芬太尼进行诱导,并采用3 ng·mL-1瑞芬太尼维持。使用OAA/S评估患者镇静水平,记录不同时间点心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、脑电双频指数(BIS)值和丙泊酚效应室浓度。结果 B组和C组在插管前(t1)至拔管前(t5)之间丙泊酚效应室浓度均显著低于A组(P<0.05)。在拔管后1 min(t6)时,C组丙泊酚效应室浓度显著低于A组(P<0.05)。状态熵(SE)(r=0.84)和响应熵(RE)(r=0.85)与丙泊酚效应室浓度之间的相关系数相似。随着OAA/S评分的降低,SE和RE均下降。瑞芬太尼以浓度依赖性方式输注,导致LVC和LRP的SE和RE值更高。结论 采用瑞芬太尼进行麻醉诱导和维持可降低丙泊酚靶控输注诱导期间的效应室浓度和丙泊酚用量,SE和RE预测OAA/S、LVC和LRP准确。

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刘龙娟
孔重红
关键词 瑞芬太尼丙泊酚麻醉药阿片类药物效应室浓度    
Abstract

Objective The encephalic entropy index (M-Etronpy) was used as an indicator of anesthesia sedation depth to investigate the effect of two doses of remifentanil on the concentration of effect compartment and the depth of anesthesia during propofol-controlled infusion. Methods A total of 81 patients requiring general anesthesia were divided into A, B and C groups (n=27) according to different target concentrations of remifentanil.Group A received 0.9% sodium chloride injection for anesthesia induction and maintenance, group B received 2 ng·mL-1 remifentanil, group C was subjected to 4 ng·mL-1remifentanil for anesthesia induction and post-intubation 3 ng·mL-1 remifentanil for anesthesia maintenance.The level of sedation was assessed using OAA/S by the anaesthesiologist.The HR, MAP, SpO2, BIS values, SE, RE, and propofol effector chamber concentrations at different time points were recorded. Results Compared with group A, the concentrations of propofol in the group B and C were significantly decreased from t1 to t5 (P<0.05).At t6, the propofol effector concentration in group C was significantly lower than that in group A (P<0.05).The correlation coefficient between SE (r=0.84) and RE (r=0.85) and propofol effector chamber concentrations were similar.SE and RE decreased in all groups with decreasing OAA/S scores.Remifentanil infusion, in a concentration-dependent matter, resulted in higher values for SE and RE at LVC and LRP. Conclusion Induction and maintenance of anesthesia with remifentanil can reduce effector chamber concentration and propofol dosage during propofol target-controlled infusion induction, SE and RE to predict OAA/S, LVC and LRP are accurate.

Key wordsRemifentanil    Propofol    Anaesthetics    Analgesics opioid    Compartment concentration
收稿日期: 2018-03-26      出版日期: 2019-06-11
引用本文:   
刘龙娟,孔重红. 不同剂量瑞芬太尼对丙泊酚靶控输注诱导期效应室浓度和麻醉深度的影响[J]. 医药导报, 2019, 38(6): 742-746.
Longjuan LIU,Zhonghong KONG. Effect of Different Doses of Remifentanil on the Concentration of Effect Compartment and the Depth of Anesthesia in the Induction Period of Propofol Target Infusion. Herald of Medicine, 2019, 38(6): 742-746.
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http://www.yydbzz.com/CN/10.3870/j.issn.1004-0781.2019.06.012      或      http://www.yydbzz.com/CN/Y2019/V38/I6/742
组别 性别 年龄/
身高/
cm
体质量/
kg
A组 13 14 52.1±14.4 165.8±9.8 67.9±15.6
B组 12 15 54.7±16.6 163.9±8.9 69.7±14.4
C组 13 14 53.2±15.9 166.2±8.9 72.4±11.6
表1  3组患者一般资料比较
组别与
时间
HR/
(次·min-1)
MAP/
mmHg
SpO2 BIS
%
A组
t0 81±15 88±11 98±1 96±2
t1 70±10*1 73±7*1 99±0 47±8
t2 96±17*1 99±13*1 99±0 49±7
t3 80±14 86±9 99±0 48±8
t4 83±15 85±10 99±0 48±7
t5 95±16*1 90±9 99±0 88±9
t6 103±19*1 101±11*1 99±0 91±6
t7 89±15*2 92±10*2 96±2*1 92±3
B组
t0 80±17 90±9 98±1 95±3
t1 71±12*1 75±9*1 99±0 46±7
t2 87±15*2 89±11*3 99±0 47±7
t3 76±12 80±6*2 99±0 47±8
t4 76±15 80±7 99±0 48±8
t5 84±16*3 84±10 99±0 88±7
t6 88±15*1*3 89±11*3 99±0 90±4
t7 76±13*3 83±7*3 95±2*2*3 90±5
C组
t0 79±15 89±9 98±1 96±3
t1 69±11*1 76±10*1 99±0 48±6
t2 84±17*3 86±10*3 99±0 48±8
t3 75±12 79±7*2 99±0 50±5
t4 78±14 83±8 99±0 47±6
t5 83±15*3 85±9 99±0 89±8
t6 87±14*1*3 90±11*3 99±0 91±4
t7 77±14*3 84±8*3 96±2*1 91±4
表2  3组各时点HR、MAP、SpO2和BIS比较
组别 t1 t2 t3 t4 t5 t6 t7
A组 2.4±0.5 2.6±0.5 2.9±0.6 3.2±0.7 2.6±0.6 1.5±0.4 1.3±0.3
B组 1.7±0.4*1 1.8±0.4*1 1.8±0.5*1 2.0±0.4*1 1.7±0.5*1 1.2±0.3 1.1±0.3
C组 1.2±0.5*1 1.2±0.3*1 1.4±0.4*1 1.7±0.5*1 1.3±0.4*1 1.0±0.2*1 1.0±0.2
表3  3组患者不同时间点丙泊酚效应室浓度比较
图1  3组在不同丙泊酚效应室浓度原始数据的非线性回归分析
A.状态熵(SE);B.响应熵(RE)
图2  3组患者响应熵(RE)和状态熵(SE)的每个OAA/S得分的原始数据
组别 意识丧失(LVC)
SE RE
ED50 95%CI ED95 ED50 95%CI ED95
A组 64 (62,66) 53 70 (68,72) 57
B组 68 (67,69)*1 60 74 (73,75) 69*1
C组 70 (68,72)*1 54 81 (80,83)*1 68*1
组别 对疼痛刺激反应丧失(LRP)
SE RE
ED50 95%CI ED95 ED50 95%CI ED95
A组 37 (34,40) 22 39 (36,42) 22
B组 50 (49,51)*1 39*1 53 (52,54)*1 41*1
C组 53 (51,55)*1 32*1 59 (57,61)*1 34*1
表4  3组50%和95%受试者中熵指数
图3  LVC、LRP与RE和SE的概率
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