国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2010年
2期
139-142
,共4页
异丙酚%瑞芬太尼%舒芬太尼%靶控输注%喉罩
異丙酚%瑞芬太尼%舒芬太尼%靶控輸註%喉罩
이병분%서분태니%서분태니%파공수주%후조
Propofol%Remifentanil%Sufentanil%Target controlled infusion%Laryngeal mask airway
目的 比较靶控输注瑞芬太尼或舒芬太尼对异丙酚喉罩麻醉作用的影响.方法 60例择期手术患者,分别采用异丙酚(P组,n=20)、异丙酚瑞芬太尼(PR组,n=20)、异丙酚舒芬太尼(PS组,n=20)静脉靶控输注.瑞芬太尼麻醉诱导时靶浓度为4 ng/ml,术中维持靶浓度调节范围为2～6 ng/ml,舒芬太尼诱导时靶浓度为0.5 ng/ml,术中维持靶浓度调节范围为0.2～1 ng/ml,预期手术结束前30 min靶浓度设定为0.2 ng/ml,异丙酚初始靶浓度为2 μg/ml,逐渐增加靶浓度值直至意识消失.术中调整异丙酚、瑞芬太尼、舒芬太尼靶浓度维持麻醉深度.观察喉罩置人前后血流动力学、以及麻醉药用量、麻醉后恢复情况.结果 三组患者诱导后收缩压(SP)、舒张压(DP)明显降低(P值<0.05),PR组心率明显减慢(P值<0.05),PR、PS组喉罩置入前后SP、DP无明显改变,P组则明显升高(P值<0.05). PR组、PS组异丙酚麻醉维持用量分别较P组降低32.7%、35.5%(P值<0.05). PS组睁眼时患者自主呼吸的ET-CO2值明显高于P组和PR组(P值<0.05),停药至患者自主呼吸ET-CO2降至45mmHg以下的时间也明显长于P组和PR组(P值<0.05).结论 瑞芬太尼、舒芬太尼均能明显减少全静脉喉罩麻醉时异丙酚用量,抑制喉罩置入的反应,但舒芬太尼会延迟麻醉苏醒期喉罩拔除时间.
目的 比較靶控輸註瑞芬太尼或舒芬太尼對異丙酚喉罩痳醉作用的影響.方法 60例擇期手術患者,分彆採用異丙酚(P組,n=20)、異丙酚瑞芬太尼(PR組,n=20)、異丙酚舒芬太尼(PS組,n=20)靜脈靶控輸註.瑞芬太尼痳醉誘導時靶濃度為4 ng/ml,術中維持靶濃度調節範圍為2～6 ng/ml,舒芬太尼誘導時靶濃度為0.5 ng/ml,術中維持靶濃度調節範圍為0.2～1 ng/ml,預期手術結束前30 min靶濃度設定為0.2 ng/ml,異丙酚初始靶濃度為2 μg/ml,逐漸增加靶濃度值直至意識消失.術中調整異丙酚、瑞芬太尼、舒芬太尼靶濃度維持痳醉深度.觀察喉罩置人前後血流動力學、以及痳醉藥用量、痳醉後恢複情況.結果 三組患者誘導後收縮壓(SP)、舒張壓(DP)明顯降低(P值<0.05),PR組心率明顯減慢(P值<0.05),PR、PS組喉罩置入前後SP、DP無明顯改變,P組則明顯升高(P值<0.05). PR組、PS組異丙酚痳醉維持用量分彆較P組降低32.7%、35.5%(P值<0.05). PS組睜眼時患者自主呼吸的ET-CO2值明顯高于P組和PR組(P值<0.05),停藥至患者自主呼吸ET-CO2降至45mmHg以下的時間也明顯長于P組和PR組(P值<0.05).結論 瑞芬太尼、舒芬太尼均能明顯減少全靜脈喉罩痳醉時異丙酚用量,抑製喉罩置入的反應,但舒芬太尼會延遲痳醉囌醒期喉罩拔除時間.
목적 비교파공수주서분태니혹서분태니대이병분후조마취작용적영향.방법 60례택기수술환자,분별채용이병분(P조,n=20)、이병분서분태니(PR조,n=20)、이병분서분태니(PS조,n=20)정맥파공수주.서분태니마취유도시파농도위4 ng/ml,술중유지파농도조절범위위2～6 ng/ml,서분태니유도시파농도위0.5 ng/ml,술중유지파농도조절범위위0.2～1 ng/ml,예기수술결속전30 min파농도설정위0.2 ng/ml,이병분초시파농도위2 μg/ml,축점증가파농도치직지의식소실.술중조정이병분、서분태니、서분태니파농도유지마취심도.관찰후조치인전후혈류동역학、이급마취약용량、마취후회복정황.결과 삼조환자유도후수축압(SP)、서장압(DP)명현강저(P치<0.05),PR조심솔명현감만(P치<0.05),PR、PS조후조치입전후SP、DP무명현개변,P조칙명현승고(P치<0.05). PR조、PS조이병분마취유지용량분별교P조강저32.7%、35.5%(P치<0.05). PS조정안시환자자주호흡적ET-CO2치명현고우P조화PR조(P치<0.05),정약지환자자주호흡ET-CO2강지45mmHg이하적시간야명현장우P조화PR조(P치<0.05).결론 서분태니、서분태니균능명현감소전정맥후조마취시이병분용량,억제후조치입적반응,단서분태니회연지마취소성기후조발제시간.
Objective To evaluate the influence of Remifentanil and Sufentanil on effect of Propofol anesthesia with laryngeal mask airway ventilation. Methods Sixty patients scheduled for elective surgery were randomly divided into propofol group ( group P, n=20 ), propofol with remifentanil group ( group PR, n=20 ) and propofol with sufentanil group ( group PS, n=20 ) .The patients were anesthetized with target controlled infusion of Propofol and RemifentaniK 4 ng/ml) or Sufentanil ( 0.5 ng/ml ).The initial target plasma concentration of Propofol was 2 μ g/ml, and increased step by step until loss of consciousness.The hemodynamic changes and the dosage of Propofol and recovery of anesthesia were observed in all patients.Results Blood pressure was significantly lower in all groups,and HR decreased in PR group after induction of anesthesia(P<0.05 ).Systolic and diastolic blood pressure increased significantly after laryngeal mask airway insertion in group P.The dosage of Propofol required for maintenance of anesthesia in group PR and group PS were reduced by 32.7% and 35.5% respectively.ET-CO2 by spontaneously breathing was higher in the PS group than in group P and group PR when the patients opened their eyes.The times from drug withdrawal to ET-C02 drop to 45mmHg by spontaneously breathing were longer in the PS group than in group P and group PR.Conclusions Remifentanil and sufentanil can reduce significantly the dosage of propofol for anesthesia with laryngeal mask airway ventilation, inhibit the hemodynamic responses to laryngeal mask airway insertion.But the times of laryngeal mask airway extubation could be prolonged by sufentanil during the revitalization of anesthesia.
