中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
4期
293-295
,共3页
朱敏敏%徐建国%何慧梁%古妙宁%吴琨%张亚军%黄勇%赵诗斌%孟轶男%李丽伶%汪炜健
硃敏敏%徐建國%何慧樑%古妙寧%吳琨%張亞軍%黃勇%趙詩斌%孟軼男%李麗伶%汪煒健
주민민%서건국%하혜량%고묘저%오곤%장아군%황용%조시빈%맹질남%리려령%왕위건
舒芬太尼%二异丙酚%药物释放系统%血液动力学现象
舒芬太尼%二異丙酚%藥物釋放繫統%血液動力學現象
서분태니%이이병분%약물석방계통%혈액동역학현상
Sufentanil%Propofol%Drug delivery systems%Hemodynamic phenomena
目的 评价不同剂量舒芬太尼复合靶控输注异丙酚麻醉诱导对患者血液动力学的影响,探讨复合异丙酚时舒芬太尼的适宜麻醉诱导剂量.方法 本试验为前瞻性、多中心、随机、双盲的临床研究.拟行腹部手术患者165例,ASA Ⅰ或Ⅱ级,年龄18～63岁,性别不限,体重42～90 kg,根据舒芬太尼不同麻醉诱导剂量分为4组:舒芬太尼0.4 μg/kg组(S1组,n=44)、0.6 μg/kg组(S2组,n=43)、0.8 μg/kg组(S3组,n=38)、1 μg/kg组(S4组,n=40).麻醉诱导:静脉注射咪达唑仑0.05 mg/kg,靶控输注异丙酚,血浆靶浓度3.0 μg/ml,当BIS<60且异丙酚达设定血浆靶浓度时,各组经30 s分别静脉注射舒芬太尼0.4、0.6、0.8、1 μg/kg,四组均静脉注射罗库溴铵0.9 mg/kg,静脉注射舒芬太尼后3 min(BIS 35～45)行气管插管、机械通气.于麻醉诱导前(T0)、异丙酚血浆靶浓度3.0 μg/ml时(T1)、静脉注射舒芬太尼后1 min(T2)、3 min(T3)、气管插管后即刻(T4)、1 min(T5)、3 min(T6)、5 min(T7)时记录SP、DP、MAP和HR.记录心血管不良事件和气管插管反应的发生情况.结果 四组麻醉诱导期间低血压、高血压和心动过速的发生率比较差异无统计学意义(P>0.05),T4-7时S4组心动过缓发生率较其余各组升高(P<0.05);S1组和S2组气管插管反应发生率较S3组和S4组升高(P<0.05或0.01).结论 舒芬太尼0.8 μg/kg复合靶控输注异丙酚(血浆靶浓度3.0 μg/ml)麻醉诱导时患者血液动力学平稳,是复合异丙酚时舒芬太尼适宜的麻醉诱导剂量.
目的 評價不同劑量舒芬太尼複閤靶控輸註異丙酚痳醉誘導對患者血液動力學的影響,探討複閤異丙酚時舒芬太尼的適宜痳醉誘導劑量.方法 本試驗為前瞻性、多中心、隨機、雙盲的臨床研究.擬行腹部手術患者165例,ASA Ⅰ或Ⅱ級,年齡18～63歲,性彆不限,體重42～90 kg,根據舒芬太尼不同痳醉誘導劑量分為4組:舒芬太尼0.4 μg/kg組(S1組,n=44)、0.6 μg/kg組(S2組,n=43)、0.8 μg/kg組(S3組,n=38)、1 μg/kg組(S4組,n=40).痳醉誘導:靜脈註射咪達唑崙0.05 mg/kg,靶控輸註異丙酚,血漿靶濃度3.0 μg/ml,噹BIS<60且異丙酚達設定血漿靶濃度時,各組經30 s分彆靜脈註射舒芬太尼0.4、0.6、0.8、1 μg/kg,四組均靜脈註射囉庫溴銨0.9 mg/kg,靜脈註射舒芬太尼後3 min(BIS 35～45)行氣管插管、機械通氣.于痳醉誘導前(T0)、異丙酚血漿靶濃度3.0 μg/ml時(T1)、靜脈註射舒芬太尼後1 min(T2)、3 min(T3)、氣管插管後即刻(T4)、1 min(T5)、3 min(T6)、5 min(T7)時記錄SP、DP、MAP和HR.記錄心血管不良事件和氣管插管反應的髮生情況.結果 四組痳醉誘導期間低血壓、高血壓和心動過速的髮生率比較差異無統計學意義(P>0.05),T4-7時S4組心動過緩髮生率較其餘各組升高(P<0.05);S1組和S2組氣管插管反應髮生率較S3組和S4組升高(P<0.05或0.01).結論 舒芬太尼0.8 μg/kg複閤靶控輸註異丙酚(血漿靶濃度3.0 μg/ml)痳醉誘導時患者血液動力學平穩,是複閤異丙酚時舒芬太尼適宜的痳醉誘導劑量.
목적 평개불동제량서분태니복합파공수주이병분마취유도대환자혈액동역학적영향,탐토복합이병분시서분태니적괄의마취유도제량.방법 본시험위전첨성、다중심、수궤、쌍맹적림상연구.의행복부수술환자165례,ASA Ⅰ혹Ⅱ급,년령18～63세,성별불한,체중42～90 kg,근거서분태니불동마취유도제량분위4조:서분태니0.4 μg/kg조(S1조,n=44)、0.6 μg/kg조(S2조,n=43)、0.8 μg/kg조(S3조,n=38)、1 μg/kg조(S4조,n=40).마취유도:정맥주사미체서륜0.05 mg/kg,파공수주이병분,혈장파농도3.0 μg/ml,당BIS<60차이병분체설정혈장파농도시,각조경30 s분별정맥주사서분태니0.4、0.6、0.8、1 μg/kg,사조균정맥주사라고추안0.9 mg/kg,정맥주사서분태니후3 min(BIS 35～45)행기관삽관、궤계통기.우마취유도전(T0)、이병분혈장파농도3.0 μg/ml시(T1)、정맥주사서분태니후1 min(T2)、3 min(T3)、기관삽관후즉각(T4)、1 min(T5)、3 min(T6)、5 min(T7)시기록SP、DP、MAP화HR.기록심혈관불량사건화기관삽관반응적발생정황.결과 사조마취유도기간저혈압、고혈압화심동과속적발생솔비교차이무통계학의의(P>0.05),T4-7시S4조심동과완발생솔교기여각조승고(P<0.05);S1조화S2조기관삽관반응발생솔교S3조화S4조승고(P<0.05혹0.01).결론 서분태니0.8 μg/kg복합파공수주이병분(혈장파농도3.0 μg/ml)마취유도시환자혈액동역학평은,시복합이병분시서분태니괄의적마취유도제량.
Objective To investigate the effects of different doses of sufentanil combined with target controlled infusion (TCI) of propofol on hemodynamics in patients during anesthesia induction and the appropriate dose of sufentanil. Methods This was a prospective, multicenter, randomized, double-blind clinical trial. One hundred and sixty-five patients of both sexes, ASA Ⅰ or Ⅱ , aged 18-63 yr, weighing 42-90 kg, scheduled for elective abdominal surgery, were divided into 4 groups according to the different induction doses of sufentanil: snfentanil 0.4 μg/kg group (group S1, n=44), 0.6 μg/kg group (group S2, n=43), 0.8 μg/kg group (group S3, n=38) and 1 μg/kg group (group S4, n=40). Anesthesia was induced with iv injection of midazolam 0.05 mg/kg, TCI of propofol (target plasma concentration set at 3.0 μg/ml) and iv injection of sufentanil 0.4, 0.6, 0.8 and 1 μg/kg. Tracheal intubation was facilitated with rocuronium 0.9 mg/kg. The patients were mechanically ventilated (BIS at 35-45). Systolic pressure (SP), diastolic pressure (DP), MAP and HR were recorded before induction of anaesthesia (T0), at the time of propofol achieving the target plasma concentration of 3.0 μg/ml (T1), at 1 min (T2) and 3 min(T3) after injection of sufentanil, and immediately (T4) and at 1 min (T5), 3 min (T6) and 5 min (T7) after tracheal intubation. The adverse cardiovascular events including bradycardia, tachycardia, hypertension and hypotension, and hemodynamic responses to intubation were also recorded. Results There were no significant differences in the incidence of hypotension, hypertension and tachycardia during anesthesia induction between 4 groups. The incidence of bradycardia at T4-7 was significantly higher in group S4 than in the other 3 groups. The incidence of intubation response was significantly higher in group S1 and S2 than in group S3 and S4. Conclusion Sufentanil 0.8 μg/kg is the dose of choice for anesthesia induction when combined with propofol TCI (target plasma concentration set at 3.0 μg/ml) in patients and hemodynamics is stable.
