中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
5期
891-895
,共5页
王伟芝%罗艳华%孙学成%张彩云%纪凡层
王偉芝%囉豔華%孫學成%張綵雲%紀凡層
왕위지%라염화%손학성%장채운%기범층
喉镜%应激%瑞芬太尼%二异丙酚%靶控输注
喉鏡%應激%瑞芬太尼%二異丙酚%靶控輸註
후경%응격%서분태니%이이병분%파공수주
Laryngoscopes%Stress%Fentanyl%Propofol%Target controlled infusion
目的：观察靶控输注（TCI）不同靶浓度瑞芬太尼对支撑喉镜手术患者术中应激性指标皮质醇和炎性因子白介素-6（IL-6）的影响。方法择期成人声带息肉摘除手术患者60例，ASAⅠ或Ⅱ级，入室后监测心电图（ECG）、心率（HR）、脉搏氧饱和度（SpO2）、无创动脉压（NIBP）。瑞芬太尼和异丙酚均进行TCI，异丙酚TCI血浆靶控浓度为4μg/ml。瑞芬太尼根据TCI浓度分为五组（1组5 ng/ml，2组4.2 ng/ml，3组3.5 ng/ml，4组2.9 ng/ml，5组2.4 ng/ml）。患者意识消失后（OAA/S≤2）给予维库溴铵0.1 mg/kg，纯氧通气3 min后气管插管。气管插管完成后连接麻醉机。3 min后进行支撑喉镜置入，继而完成手术。记录患者HR、平均动脉压（MAP），数据采集的时间点为：基础值，诱导后，支撑喉镜置入前，支撑喉镜置入后3 min内最高值。每个数值记录3次，取其平均值。于支撑喉镜置入前、支撑喉镜置入后3 min抽取血样，采用放射免疫法测量应激性指标皮质醇和IL-6。比较各靶控浓度组内患者支撑喉镜置入前、后的皮质醇、IL-6的变化。并记录各个时点的镇静警醒评分。结果患者一般资料无统计学差异。通过对诱导后与基础值HR、MAP的比较，可以观察到，瑞芬太尼靶控浓度在5 ng/ml和4.2 ng/ml时可以引起较明显的心血管系统抑制，表现为HR、MAP测量值下降（P＜0.05）；通过对支撑喉镜置入前后HR、MAP的比较和对支撑喉镜置入前后血样本中皮质醇、IL-6数值的比较，可以观察到，瑞芬太尼靶控浓度在2.9 ng/ml和2.4 ng/ml时，很难有效抑制支撑喉镜引起的应激反应，表现为HR、MAP、皮质醇和IL-6数值上升（P＜0.05）。全部患者诱导后、支撑喉镜置入前、后的OAA/S评分均为1。结论伍用异丙酚TCI浓度4μg/ml时，瑞芬太尼TCI浓度3.5 ng/ml能够有效抑制支撑喉镜应激反应而又不会引起严重的诱导抑制。
目的：觀察靶控輸註（TCI）不同靶濃度瑞芬太尼對支撐喉鏡手術患者術中應激性指標皮質醇和炎性因子白介素-6（IL-6）的影響。方法擇期成人聲帶息肉摘除手術患者60例，ASAⅠ或Ⅱ級，入室後鑑測心電圖（ECG）、心率（HR）、脈搏氧飽和度（SpO2）、無創動脈壓（NIBP）。瑞芬太尼和異丙酚均進行TCI，異丙酚TCI血漿靶控濃度為4μg/ml。瑞芬太尼根據TCI濃度分為五組（1組5 ng/ml，2組4.2 ng/ml，3組3.5 ng/ml，4組2.9 ng/ml，5組2.4 ng/ml）。患者意識消失後（OAA/S≤2）給予維庫溴銨0.1 mg/kg，純氧通氣3 min後氣管插管。氣管插管完成後連接痳醉機。3 min後進行支撐喉鏡置入，繼而完成手術。記錄患者HR、平均動脈壓（MAP），數據採集的時間點為：基礎值，誘導後，支撐喉鏡置入前，支撐喉鏡置入後3 min內最高值。每箇數值記錄3次，取其平均值。于支撐喉鏡置入前、支撐喉鏡置入後3 min抽取血樣，採用放射免疫法測量應激性指標皮質醇和IL-6。比較各靶控濃度組內患者支撐喉鏡置入前、後的皮質醇、IL-6的變化。併記錄各箇時點的鎮靜警醒評分。結果患者一般資料無統計學差異。通過對誘導後與基礎值HR、MAP的比較，可以觀察到，瑞芬太尼靶控濃度在5 ng/ml和4.2 ng/ml時可以引起較明顯的心血管繫統抑製，錶現為HR、MAP測量值下降（P＜0.05）；通過對支撐喉鏡置入前後HR、MAP的比較和對支撐喉鏡置入前後血樣本中皮質醇、IL-6數值的比較，可以觀察到，瑞芬太尼靶控濃度在2.9 ng/ml和2.4 ng/ml時，很難有效抑製支撐喉鏡引起的應激反應，錶現為HR、MAP、皮質醇和IL-6數值上升（P＜0.05）。全部患者誘導後、支撐喉鏡置入前、後的OAA/S評分均為1。結論伍用異丙酚TCI濃度4μg/ml時，瑞芬太尼TCI濃度3.5 ng/ml能夠有效抑製支撐喉鏡應激反應而又不會引起嚴重的誘導抑製。
목적：관찰파공수주（TCI）불동파농도서분태니대지탱후경수술환자술중응격성지표피질순화염성인자백개소-6（IL-6）적영향。방법택기성인성대식육적제수술환자60례，ASAⅠ혹Ⅱ급，입실후감측심전도（ECG）、심솔（HR）、맥박양포화도（SpO2）、무창동맥압（NIBP）。서분태니화이병분균진행TCI，이병분TCI혈장파공농도위4μg/ml。서분태니근거TCI농도분위오조（1조5 ng/ml，2조4.2 ng/ml，3조3.5 ng/ml，4조2.9 ng/ml，5조2.4 ng/ml）。환자의식소실후（OAA/S≤2）급여유고추안0.1 mg/kg，순양통기3 min후기관삽관。기관삽관완성후련접마취궤。3 min후진행지탱후경치입，계이완성수술。기록환자HR、평균동맥압（MAP），수거채집적시간점위：기출치，유도후，지탱후경치입전，지탱후경치입후3 min내최고치。매개수치기록3차，취기평균치。우지탱후경치입전、지탱후경치입후3 min추취혈양，채용방사면역법측량응격성지표피질순화IL-6。비교각파공농도조내환자지탱후경치입전、후적피질순、IL-6적변화。병기록각개시점적진정경성평분。결과환자일반자료무통계학차이。통과대유도후여기출치HR、MAP적비교，가이관찰도，서분태니파공농도재5 ng/ml화4.2 ng/ml시가이인기교명현적심혈관계통억제，표현위HR、MAP측량치하강（P＜0.05）；통과대지탱후경치입전후HR、MAP적비교화대지탱후경치입전후혈양본중피질순、IL-6수치적비교，가이관찰도，서분태니파공농도재2.9 ng/ml화2.4 ng/ml시，흔난유효억제지탱후경인기적응격반응，표현위HR、MAP、피질순화IL-6수치상승（P＜0.05）。전부환자유도후、지탱후경치입전、후적OAA/S평분균위1。결론오용이병분TCI농도4μg/ml시，서분태니TCI농도3.5 ng/ml능구유효억제지탱후경응격반응이우불회인기엄중적유도억제。
Objective To determine the influence of Remifentanil TCI on irritable index:cortisol and inflammatory index: interleukin-6 of patients undergoing laryngoscope operation. Methods Sixty physical status Ⅰ or Ⅱ patients undergoing vocal cord polypectomy were selected. Electrocardiogram (ECG), heart rate (HR) and pulse oxygen saturation (SpO2) were monitored. Arterial blood pressure (ABP) was monitored after an arteria radialis puncturation made with local anesthesia. Both remifentanil and propofol were target controlled infused. All patients were divided into 5 groups according to the plasma target controlled concentration of remifentanil (1 group 5 ng/ml, 2 group 4.2 ng/ml, 3 group 3.5 ng/ml, 4 group 2.9 ng/ml, 5 group 2.4 ng/ml). Propofol was initiated with TCI at 4μg/ml. Vecuronium Bromide was given at 0.1 mg/kg after patients losing consciousness (OAA/S≤2) and intubation was given after pure oxygen given 3 min. Then anaesthetic machine was connected. 3 minute later laryngeal endoscope was inserted, and then operation was carried on. Heart rate (HR) and mean blood press (MBP) after induction and before laryngoscope used and the highest data in 3 minute were recorded. Regard data of lying calmly as base data. Every data was observed thrice and the average data was recorded. Blood samples were taken before and after laryngoscope used 3 min. Irritable index: cortisol and inflammatory index: interleukin-6 were measured with radio-immunity method, Variations of cortisol and interleukin-6 and blood glucose before laryngoscope used were compared. Observer's Assessment of Alert/Sedation Scale (OAA/S) was recorded at all times. Results General data of patients had no statistical difference. HR and MBP of basic data and after induction were observed, with the same target controlled concentration of propofol, remifentanil may induce inhibition of cardiovascular system at 5 ng/ml and 4.2 ng/ml, with HR and MBP decreasing obviously (P<0.05); HR, MBP before and after laryngoscope used, and the value of plasma cortisol and interleukin-6 and blood glucose before and after laryngoscope used were observed. Remifentanil can hardly effectively inhibit laryngoscope irritable response at 2.9 ng/ml and 2.4 ng/ml, with HR, MBP, cortisol and interleukin-6 increasing dramatically (P<0.05). OAA/S of all patients after induction, before and after laryngoscope used was 1. Conclusions Propofol target controlled infusion at 4μg/ml can sustain enough sedation. Remifentanil target controlled infusion at 3.5 ng/ml could inhibit laryngoscope irritable response and avoid severe induction response.
