医药导报
醫藥導報
의약도보
HERALD OF MEDICINE
2014年
7期
895-899
,共5页
郭瑞%曾丽蓉%何婉雯%王立勋%零达尚%李瑞钰
郭瑞%曾麗蓉%何婉雯%王立勛%零達尚%李瑞鈺
곽서%증려용%하완문%왕립훈%령체상%리서옥
丙泊酚%术中唤醒%NI指数%血流动力学%外显记忆
丙泊酚%術中喚醒%NI指數%血流動力學%外顯記憶
병박분%술중환성%NI지수%혈류동역학%외현기억
Propofol%Intraoperative wake-up%Narcotrend index%Hemodynamics%Explicit memory
目的:观察一定效应室浓度瑞芬太尼背景下,不同亚效应室浓度丙泊酚对术中唤醒的影响,探寻丙泊酚合理的亚效应室浓度。方法150例ASA分级I或Ⅱ级患者,随机分为R1~R5组各30例。唤醒前均调整瑞芬太尼靶控输注(TCI)浓度为2.4μg·L-1并复合输注丙泊酚:对照组R1输注等量0.9%氯化钠注射液;各观察组TCI丙泊酚,R2组0.5 mg·L-1,R3组1.0 mg·L-1,R4组1.5 mg·L-1,R5组2.0 mg·L-1。观察调整丙泊酚即刻(t0)、唤醒开始即刻(t1)、应答期( t2)、唤醒结束静脉注射丙泊酚后5 min( t3)时的平均动脉压( MAP)、心率( HR)及Narcotrend Index ( NI)以及唤醒时间(t),并随访术后外显记忆消除情况。结果①R1、R2、R3组唤醒时间及NI差异无统计学意义(P>0.05),R4、R5组NI低于前3组(P<0.05),唤醒时间则长于前3组(P<0.05)。②R3、R4、R5组MAP、HR及外显记忆差异无统计学意义(P>0.05),并均低于R1、R2组(P<0.05)。结论靶控输注瑞芬太尼2.4μg·L-1并复合输注丙泊酚1.0 mg·L-1时不影响唤醒可控性,循环更理想、稳定,能更好地消除患者术后对唤醒过程的外显记忆。
目的:觀察一定效應室濃度瑞芬太尼揹景下,不同亞效應室濃度丙泊酚對術中喚醒的影響,探尋丙泊酚閤理的亞效應室濃度。方法150例ASA分級I或Ⅱ級患者,隨機分為R1~R5組各30例。喚醒前均調整瑞芬太尼靶控輸註(TCI)濃度為2.4μg·L-1併複閤輸註丙泊酚:對照組R1輸註等量0.9%氯化鈉註射液;各觀察組TCI丙泊酚,R2組0.5 mg·L-1,R3組1.0 mg·L-1,R4組1.5 mg·L-1,R5組2.0 mg·L-1。觀察調整丙泊酚即刻(t0)、喚醒開始即刻(t1)、應答期( t2)、喚醒結束靜脈註射丙泊酚後5 min( t3)時的平均動脈壓( MAP)、心率( HR)及Narcotrend Index ( NI)以及喚醒時間(t),併隨訪術後外顯記憶消除情況。結果①R1、R2、R3組喚醒時間及NI差異無統計學意義(P>0.05),R4、R5組NI低于前3組(P<0.05),喚醒時間則長于前3組(P<0.05)。②R3、R4、R5組MAP、HR及外顯記憶差異無統計學意義(P>0.05),併均低于R1、R2組(P<0.05)。結論靶控輸註瑞芬太尼2.4μg·L-1併複閤輸註丙泊酚1.0 mg·L-1時不影響喚醒可控性,循環更理想、穩定,能更好地消除患者術後對喚醒過程的外顯記憶。
목적:관찰일정효응실농도서분태니배경하,불동아효응실농도병박분대술중환성적영향,탐심병박분합리적아효응실농도。방법150례ASA분급I혹Ⅱ급환자,수궤분위R1~R5조각30례。환성전균조정서분태니파공수주(TCI)농도위2.4μg·L-1병복합수주병박분:대조조R1수주등량0.9%록화납주사액;각관찰조TCI병박분,R2조0.5 mg·L-1,R3조1.0 mg·L-1,R4조1.5 mg·L-1,R5조2.0 mg·L-1。관찰조정병박분즉각(t0)、환성개시즉각(t1)、응답기( t2)、환성결속정맥주사병박분후5 min( t3)시적평균동맥압( MAP)、심솔( HR)급Narcotrend Index ( NI)이급환성시간(t),병수방술후외현기억소제정황。결과①R1、R2、R3조환성시간급NI차이무통계학의의(P>0.05),R4、R5조NI저우전3조(P<0.05),환성시간칙장우전3조(P<0.05)。②R3、R4、R5조MAP、HR급외현기억차이무통계학의의(P>0.05),병균저우R1、R2조(P<0.05)。결론파공수주서분태니2.4μg·L-1병복합수주병박분1.0 mg·L-1시불영향환성가공성,순배경이상、은정,능경호지소제환자술후대환성과정적외현기억。
Objective To compare the effects of five different target-controlled concentrations of propofol combined with finite concentration of remifentanil on intraoperative awareness,so as to determine the safer and more effective concentration of propofol which could decrease explicit memory and reduce the incidence of intraoperative awareness. Methods One hundred and fifty patients ( ASAⅠ-Ⅱ) were randomly divided into five groups. There was no significant difference between each group in general condition. Before awaking,the target controlled concentration of remifentanil was adjusted to 2. 4 μg·L-1 in all five groups. Groups R1,R2,R3,R4 and R5 also received 0. 9%normal saline,0. 5 mg·L-1,1. 0 mg·L-1,1. 5 mg·L-1 and 2. 0 mg·L-1 of target controlled infusion ( TCI) of propofol, respectively. Narcotrend index ( NI), mean arterial pressure (MAP),heart rate (HR) and t [the time from t1(the time of awareness beginning) to the end of awareness] at t0(the time of adjusting propofol),t1,t2(the period of awareness),t3(wake period end 5 min) were recorded. Elimination of explicit memory after surgery was followed up. Results There were no significant differences in t and NI between groups R1,R2 and R3(P>0. 05). NI of groups R4 and R5 was significantly lower than that in groups R1,R2 and R3(P<0. 05),but t of groups R4 and R5 was longer than that in the other groups (P<0. 05). The MAP,HR and explicit memory of groups R3,R4 and R5 were lower than those in groups R1 and R2 (P<0. 05),but there were no significant differences between groups R3,R4 and R5 (P>0. 05). Conclusion Target controlled infusion of remifentanil 2. 4μg·L-1 combined with TCI propofol 1. 0 mg·L-1 does not affect the wakening controllability. The circulation was steadier and explicit memory could be eliminated during intraoperative awakening.