中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
20期
79-84
,共6页
舒芬太尼%静脉内注射%脑电双谱指数%血流动力学现象%急性等容血液稀释%血液保护
舒芬太尼%靜脈內註射%腦電雙譜指數%血流動力學現象%急性等容血液稀釋%血液保護
서분태니%정맥내주사%뇌전쌍보지수%혈류동역학현상%급성등용혈액희석%혈액보호
Sufentanil%Intravenous infusion%Bispectral index%Hemodynamics%Acute normovolemic hemodilution%Blood conservation
目的:探讨靶控输注(TCI)不同效应室浓度(Cet)舒芬太尼时急性等容血液稀释(ANH)的安全性及其术中血液保护作用。方法选取2011年3月~2013年1月择期于北京积水潭医院全麻下行双侧髋关节置换手术的患者84例,随机分为4组,每组各21例。诱导使用丙泊酚TCI及维库溴铵,分别TCI舒芬太尼至Cet为0.2 ng/mL(S1组)、0.4 ng/mL(S2组及C组)、0.6 ng/mL(S3组),C组患者术中不进行ANH。记录入室时及诱导前、TCI舒芬太尼前、舒芬太尼达Cet时、采血前(T0)、采血5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、25 min(T5)、30 min(T6)、35 min(T7)、40 min(T8)时心率(HR)、动脉血压(MAP)及脑电双谱指数(BIS)值,记录入院时、采血前及采血完成后的血细胞比容(HCT)值;记录患者术中出血量及输血量。结果①4组患者达舒芬太尼Cet时HR值均较达丙泊酚Cet时显著下降[S1组:(96.0±16.2)次/min比(84.1±16.1)次/min;S2组:(94.5±12.2)次/min比(80.1±13.0)次/min;C 组:(88.6±18.4)次/min比(74.2±10.8)次/min;S3组:(90.9±24.4)次/min比(76.3±12.1)次/min],差异均有统计学意义(P<0.05);4组患者舒芬太尼给药前、后MAP差异均无统计学意义(P>0.05)。S3组患者达舒芬太尼Cet时BIS值显著低于S1、S2及C组患者,差异有高度统计学意义(P<0.01),且较达丙泊酚Cet时显著降低(P<0.05),而S1、S2及C组患者未发现BIS值的显著变化。②S1、S2、S3组患者稀释前HCT、稀释后HCT及采血量、采血时间比较差异无统计学意义(P>0.05);S1、S2、S3组患者不同采血时间点BIS比较差异无统计学意义(P>0.05)。③S1、S2、S3组患者分别进行组内比较,T0~T8时间点其HR、MAP及BIS值比较差异均无统计学意义(P>0.05)。④与S1、S2及S3组患者比较,C组患者术中出血量明显增多(P=0.001);C组患者异体输血量明显多于S1、S2及S3组患者(P=0.022);但四组比较异体输血比例差异无统计学意义(P=0.085)。 S1、S2及S3组患者之间出血量、异体输血量及输血比例差异无统计学意义(P>0.05)。结论复合使用七氟烷及舒芬太尼维持麻醉时,ANH不会造成血流动力学不稳定及BIS值的改变;使用ANH可以减少术中出血量及异体输血,因此是一项安全有效的血液保护措施。
目的:探討靶控輸註(TCI)不同效應室濃度(Cet)舒芬太尼時急性等容血液稀釋(ANH)的安全性及其術中血液保護作用。方法選取2011年3月~2013年1月擇期于北京積水潭醫院全痳下行雙側髖關節置換手術的患者84例,隨機分為4組,每組各21例。誘導使用丙泊酚TCI及維庫溴銨,分彆TCI舒芬太尼至Cet為0.2 ng/mL(S1組)、0.4 ng/mL(S2組及C組)、0.6 ng/mL(S3組),C組患者術中不進行ANH。記錄入室時及誘導前、TCI舒芬太尼前、舒芬太尼達Cet時、採血前(T0)、採血5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、25 min(T5)、30 min(T6)、35 min(T7)、40 min(T8)時心率(HR)、動脈血壓(MAP)及腦電雙譜指數(BIS)值,記錄入院時、採血前及採血完成後的血細胞比容(HCT)值;記錄患者術中齣血量及輸血量。結果①4組患者達舒芬太尼Cet時HR值均較達丙泊酚Cet時顯著下降[S1組:(96.0±16.2)次/min比(84.1±16.1)次/min;S2組:(94.5±12.2)次/min比(80.1±13.0)次/min;C 組:(88.6±18.4)次/min比(74.2±10.8)次/min;S3組:(90.9±24.4)次/min比(76.3±12.1)次/min],差異均有統計學意義(P<0.05);4組患者舒芬太尼給藥前、後MAP差異均無統計學意義(P>0.05)。S3組患者達舒芬太尼Cet時BIS值顯著低于S1、S2及C組患者,差異有高度統計學意義(P<0.01),且較達丙泊酚Cet時顯著降低(P<0.05),而S1、S2及C組患者未髮現BIS值的顯著變化。②S1、S2、S3組患者稀釋前HCT、稀釋後HCT及採血量、採血時間比較差異無統計學意義(P>0.05);S1、S2、S3組患者不同採血時間點BIS比較差異無統計學意義(P>0.05)。③S1、S2、S3組患者分彆進行組內比較,T0~T8時間點其HR、MAP及BIS值比較差異均無統計學意義(P>0.05)。④與S1、S2及S3組患者比較,C組患者術中齣血量明顯增多(P=0.001);C組患者異體輸血量明顯多于S1、S2及S3組患者(P=0.022);但四組比較異體輸血比例差異無統計學意義(P=0.085)。 S1、S2及S3組患者之間齣血量、異體輸血量及輸血比例差異無統計學意義(P>0.05)。結論複閤使用七氟烷及舒芬太尼維持痳醉時,ANH不會造成血流動力學不穩定及BIS值的改變;使用ANH可以減少術中齣血量及異體輸血,因此是一項安全有效的血液保護措施。
목적:탐토파공수주(TCI)불동효응실농도(Cet)서분태니시급성등용혈액희석(ANH)적안전성급기술중혈액보호작용。방법선취2011년3월~2013년1월택기우북경적수담의원전마하행쌍측관관절치환수술적환자84례,수궤분위4조,매조각21례。유도사용병박분TCI급유고추안,분별TCI서분태니지Cet위0.2 ng/mL(S1조)、0.4 ng/mL(S2조급C조)、0.6 ng/mL(S3조),C조환자술중불진행ANH。기록입실시급유도전、TCI서분태니전、서분태니체Cet시、채혈전(T0)、채혈5 min(T1)、10 min(T2)、15 min(T3)、20 min(T4)、25 min(T5)、30 min(T6)、35 min(T7)、40 min(T8)시심솔(HR)、동맥혈압(MAP)급뇌전쌍보지수(BIS)치,기록입원시、채혈전급채혈완성후적혈세포비용(HCT)치;기록환자술중출혈량급수혈량。결과①4조환자체서분태니Cet시HR치균교체병박분Cet시현저하강[S1조:(96.0±16.2)차/min비(84.1±16.1)차/min;S2조:(94.5±12.2)차/min비(80.1±13.0)차/min;C 조:(88.6±18.4)차/min비(74.2±10.8)차/min;S3조:(90.9±24.4)차/min비(76.3±12.1)차/min],차이균유통계학의의(P<0.05);4조환자서분태니급약전、후MAP차이균무통계학의의(P>0.05)。S3조환자체서분태니Cet시BIS치현저저우S1、S2급C조환자,차이유고도통계학의의(P<0.01),차교체병박분Cet시현저강저(P<0.05),이S1、S2급C조환자미발현BIS치적현저변화。②S1、S2、S3조환자희석전HCT、희석후HCT급채혈량、채혈시간비교차이무통계학의의(P>0.05);S1、S2、S3조환자불동채혈시간점BIS비교차이무통계학의의(P>0.05)。③S1、S2、S3조환자분별진행조내비교,T0~T8시간점기HR、MAP급BIS치비교차이균무통계학의의(P>0.05)。④여S1、S2급S3조환자비교,C조환자술중출혈량명현증다(P=0.001);C조환자이체수혈량명현다우S1、S2급S3조환자(P=0.022);단사조비교이체수혈비례차이무통계학의의(P=0.085)。 S1、S2급S3조환자지간출혈량、이체수혈량급수혈비례차이무통계학의의(P>0.05)。결론복합사용칠불완급서분태니유지마취시,ANH불회조성혈류동역학불은정급BIS치적개변;사용ANH가이감소술중출혈량급이체수혈,인차시일항안전유효적혈액보호조시。
Objective To investigate the safety and the effect of acute normovolemic hemodilution (ANH) when target-controlled infusion (TCI) of sufentanil at various effect-site concentrations (Cet) was given. Methods 84 patients under-going bilateral hip replacement selective operation in Beijing Jishuitan Hospital from March 2011 to January 2013 were selected and divided into 4 groups with 21 cases in each group. Propofol TCI and Vecuronium were given for anesthesi-a induction, Sufentanil TCI was Cet of 0.2 ng/mL (group S1), 0.4 ng/mL (group S2, group C) and 0.6ng/mL (group S3) respectively, ANH was not used in group C. HR, MAP and BIS value were recorded after entering operating-room and before induction (baseline values), before TCI of Sufentanil, Sufentanil at target of Cet, before blood sampling (T0),the 4 groups at Sufentanil Cet were all lower than those at Propofol Cet [group S1:(96.0±16.2) times/min vs (84.1±16.1) times/min; group S2: (94.5±12.2) times/min vs (80.1±13.0)times/min; group C: (88.6±18.4) times/min vs (74.2±10.8) times/min;group S3:(90.9±24.4) times/min v s (76.3±12.1) times/min], the differences were statistically significant (P<0.05). The difference of MAP in the 4 groups before and after the Sufentanil was not statistically significant (P>0.05). The BIS value in group S3 at Sufentanil Cet were all lower than those in group S1, group S2 and group C, the dif-ferences were statistically significant (P<0.01), and all lower than those at Propofol Cet (P<0.05), no significant change of BIS value was found in group S1, group S2 and group C. ②The differences of HCT before and after dilution, collecting blood, blood sampling time in group S1, group S2, group S3 were not statistically significant (P>0.05); The differences of BIS value in group S1, group S2, group S3 at different blood sampling time point were not statistically sig-nificant (P>0.05). ③The differences of HR, MAP and BIS value of group S1, group S2, group S3 at T0-T8 time point were not statistically significant (P>0.05). ④Bleeding volume of group C were more than those of group S1, group S2, group S3 (P=0.001), the blood transfusion volume were more than those of group S1, group S2, group S3 (P=0.022). The differences of blood transfusion ratio of 4 groups were not statistically significant (P=0.085). The differences of bleeding volume, blood transfusion volume, blood transfusion ratio in group S1, group S2, group S3 were not statistically significant (P>0.05). Conclusion ANH has no impact on BIS and hemodynamic parameters when using Sulfentanil combined with Sevoflurane, and it decrease the bleeding volume and homologous blood transfusion volume, so it is a safe and effective autologous blood conservative technique.