国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
9期
603-606,633
,共5页
屈罡升%贺振秋%马雪松%李军%戚思华
屈罡升%賀振鞦%馬雪鬆%李軍%慼思華
굴강승%하진추%마설송%리군%척사화
舒芬太尼%靶控输注%腹腔镜胆囊切除术
舒芬太尼%靶控輸註%腹腔鏡膽囊切除術
서분태니%파공수주%복강경담낭절제술
Sufentanil%Target-controlled infusion%Laparoscopic cholecystectomy
目的 研究效应室靶控输注(target-controlled infusion,TCI)舒芬太尼在腹腔镜胆囊切除术中的应用,探讨合适的TCI浓度.方法 择期行腹腔镜胆囊切除术患者75例,按照随机数字表法分为5组(每组15例):舒芬太尼效应室TCI浓度0.2 μg/L组(A组)、0.3 μg/L组(B组)、0.4 μg/L组(C组)、0.5 μg/L组(D组)和芬太尼静脉推注3μg/kg组(E组).依据平均动脉压(MAP)、心率(HR)、Narcotrend指数(narcotrend index,NI)指导血管活性药物的使用及丙泊酚TCI浓度的调节.于诱导前(T0)、喉罩置入前即刻(T1)喉罩置入后即刻(T2)、喉罩置入后5 min (T3)、手术开始(T4)、气腹建立(T5)、开始游离胆囊(T6)、胆囊动脉游离完毕(T7)、切下胆囊(T8)、术毕(T9)、睁眼(T10)、拔出喉罩(T11)及离室(T12)记录MAP、HR和NI值;记录血管活性药使用情况及术中丙泊酚调节次数;记录术毕至患者清醒时间.结果 T1、T2、T3较T0时间点各组MAP和HR均明显下降(P＜0.05),其中A组3个时间点MAP分别为(75±6)、(79±7)、(75±6)mm Hg(1 mm Hg=0.133 kPa),与其他各组比较下降幅度最小;与T0比较,T6时间点各组MAP均升高(P＜0.05);在T6时间点A、B组MAP分别为(117±11)、(114±13) mm Hg,显著高于C组(P＜0.05);在T11点,B、C、D组MAP和HR低于E组(P＜0.05);术中C组丙泊酚调节(2.5±0.6)次,在所有组别中最少且未使用血管活性药物,与A、B、E组比较有统计学差异(P＜0.05);,D组患者苏醒时间为(13.3±3.4) min,与E组患者比较明显延长(P＜0.05).结论 效应室TCI舒芬太尼可有效地应用于腹腔镜胆囊切除手术,较适诱导和较适维持浓度分别为0.2、0.4 μg/L.
目的 研究效應室靶控輸註(target-controlled infusion,TCI)舒芬太尼在腹腔鏡膽囊切除術中的應用,探討閤適的TCI濃度.方法 擇期行腹腔鏡膽囊切除術患者75例,按照隨機數字錶法分為5組(每組15例):舒芬太尼效應室TCI濃度0.2 μg/L組(A組)、0.3 μg/L組(B組)、0.4 μg/L組(C組)、0.5 μg/L組(D組)和芬太尼靜脈推註3μg/kg組(E組).依據平均動脈壓(MAP)、心率(HR)、Narcotrend指數(narcotrend index,NI)指導血管活性藥物的使用及丙泊酚TCI濃度的調節.于誘導前(T0)、喉罩置入前即刻(T1)喉罩置入後即刻(T2)、喉罩置入後5 min (T3)、手術開始(T4)、氣腹建立(T5)、開始遊離膽囊(T6)、膽囊動脈遊離完畢(T7)、切下膽囊(T8)、術畢(T9)、睜眼(T10)、拔齣喉罩(T11)及離室(T12)記錄MAP、HR和NI值;記錄血管活性藥使用情況及術中丙泊酚調節次數;記錄術畢至患者清醒時間.結果 T1、T2、T3較T0時間點各組MAP和HR均明顯下降(P＜0.05),其中A組3箇時間點MAP分彆為(75±6)、(79±7)、(75±6)mm Hg(1 mm Hg=0.133 kPa),與其他各組比較下降幅度最小;與T0比較,T6時間點各組MAP均升高(P＜0.05);在T6時間點A、B組MAP分彆為(117±11)、(114±13) mm Hg,顯著高于C組(P＜0.05);在T11點,B、C、D組MAP和HR低于E組(P＜0.05);術中C組丙泊酚調節(2.5±0.6)次,在所有組彆中最少且未使用血管活性藥物,與A、B、E組比較有統計學差異(P＜0.05);,D組患者囌醒時間為(13.3±3.4) min,與E組患者比較明顯延長(P＜0.05).結論 效應室TCI舒芬太尼可有效地應用于腹腔鏡膽囊切除手術,較適誘導和較適維持濃度分彆為0.2、0.4 μg/L.
목적 연구효응실파공수주(target-controlled infusion,TCI)서분태니재복강경담낭절제술중적응용,탐토합괄적TCI농도.방법 택기행복강경담낭절제술환자75례,안조수궤수자표법분위5조(매조15례):서분태니효응실TCI농도0.2 μg/L조(A조)、0.3 μg/L조(B조)、0.4 μg/L조(C조)、0.5 μg/L조(D조)화분태니정맥추주3μg/kg조(E조).의거평균동맥압(MAP)、심솔(HR)、Narcotrend지수(narcotrend index,NI)지도혈관활성약물적사용급병박분TCI농도적조절.우유도전(T0)、후조치입전즉각(T1)후조치입후즉각(T2)、후조치입후5 min (T3)、수술개시(T4)、기복건립(T5)、개시유리담낭(T6)、담낭동맥유리완필(T7)、절하담낭(T8)、술필(T9)、정안(T10)、발출후조(T11)급리실(T12)기록MAP、HR화NI치;기록혈관활성약사용정황급술중병박분조절차수;기록술필지환자청성시간.결과 T1、T2、T3교T0시간점각조MAP화HR균명현하강(P＜0.05),기중A조3개시간점MAP분별위(75±6)、(79±7)、(75±6)mm Hg(1 mm Hg=0.133 kPa),여기타각조비교하강폭도최소;여T0비교,T6시간점각조MAP균승고(P＜0.05);재T6시간점A、B조MAP분별위(117±11)、(114±13) mm Hg,현저고우C조(P＜0.05);재T11점,B、C、D조MAP화HR저우E조(P＜0.05);술중C조병박분조절(2.5±0.6)차,재소유조별중최소차미사용혈관활성약물,여A、B、E조비교유통계학차이(P＜0.05);,D조환자소성시간위(13.3±3.4) min,여E조환자비교명현연장(P＜0.05).결론 효응실TCI서분태니가유효지응용우복강경담낭절제수술,교괄유도화교괄유지농도분별위0.2、0.4 μg/L.
Objective To study the application of sufentanil by effect compartment-controlled target-controlled infusion(TCI) during laparoscopic cholecystectomy,investigate the appropriate TCI concentration.Methods 75 patients undergoing laparoscopic cholecystectomy were randomly divided into 5 groups (n=15):sufentanil effect compartment concentration 0.2 μg/L (group A),0.3 μg/L (group B),0.4 μg/L (group C) and 0.5 μg/L (group D),fentanyl 3 μg/kg i.v.(group E).The concentration of propofol and the use of vasoactive drug were directed by MAP,HR and Narcotrend index(NI).MAP and HR were recorded at the time points of before anesthesia induction (T0),immediately before and after LMA-SupremeTM insertion (T1-2),5min after LMA-SupremeTMinsertion (T3),beginning of surgery (T4),establishment of pneumoperitoneum (T5),beginning of freeing the gallbladder (T6),end of freeing cystic artery (T7),cutting the gallbladder (T8),end of surgery (T9),eyes opening (T10),pulling out the laryngeal mask (T11),leaving off the operating room (T12).The use of vasoactive drug,times of adjusting propofol,awakening time,side effects were recorded.Results MAP and HR were significantly decreased at T1-3 compared with the baseline at T0 in all groups (P＜0.05).The MAP at T1-3 in group A were(75±6),(79±7),(75±6) mm Hg(1 mm Hg=0.133 kPa) respectively,and changed lighter than that in other groups.Compared with MAP at TO,there was significantly increased at T6 in all groups.The MAP at T6 in group A and B were (117±11 ) and (114±13) mm Hg respectively,and higher than that in group C (P＜0.05).Both MAP and HR in group B,C and D were significantly decreased at T11 compared with that in group E (P＜0.05).In group C,the times of altering propofol with (2.5±0.6) was less than that in other groups.The awakening time in group D with (13.3±3.4) min was longer than that in group E (P＜0.05).Conclusions Sufentanil by effect compartment-controlled TCI is used well in laparoscopic cholecystectomy,the most appropriate induction and maintenance concentrations were 0.2 μg/L and 0.4 μg/L respectively.
