临床麻醉学杂志
臨床痳醉學雜誌
림상마취학잡지
THE JOURNAL OF CLINICAL ANESTHESIOLOGY
2014年
12期
1165-1168
,共4页
钟涛%杨勇%朱茂恩%聂玉琼%郭曲练
鐘濤%楊勇%硃茂恩%聶玉瓊%郭麯練
종도%양용%주무은%섭옥경%곽곡련
瑞芬太尼%丙泊酚%脑电监测%靶控输注
瑞芬太尼%丙泊酚%腦電鑑測%靶控輸註
서분태니%병박분%뇌전감측%파공수주
Remifentanil%Propofol%Electroencephalogram%Target-control infusion
目的:探讨丙泊酚 TCI 时患者意识消失(LOC)及诱发脑电爆发抑制(BS)时的效应室半数有效浓度(EC50)的影响。方法择期全麻手术患者60例,随机均分为瑞芬太尼组(R 组)和生理盐水组(N 组)。R 组:以4 ng/ml 靶浓度 TCI 瑞芬太尼10 min 后开始 TCI 丙泊酚,靶浓度从1μg/ml开始递增,递增梯度为1μg/ml,每一靶浓度输注1 min,至脑电监测爆发抑制比(BSR)达到15%后结束试验;N 组:以等量生理盐水模拟瑞芬太尼 TCI,其余方法与 R 组相同,期间所有患者每间隔20秒行改良 OAA/S 评分,改良 OAA/S 评分<2分定义为 LOC,BSR>15%定义为出现 BS 现象。记录 LOC 和 BSR 达15%时的丙泊酚 EC50及其95%可信区间(CI)。结果LOC 时 R 组丙泊酚效应室 EC50为1.73μg/ml(95%CI 1.68~1.79μg/ml),N 组为2.35μg/ml(95%CI 2.29~2.41μg/ml)(P<0.05)。BSR 达15%时 R 组和 N 组丙泊酚 EC50分别为6.25μg/ml (95%CI 6.18~6.42μg/ml)和6.31μg/ml(95%CI 6.13~6.47μg/ml),两组差异无统计学意义。结论复合 TCI 瑞芬太尼可降低丙泊酚 TCI 意识消失时的效应室 EC50,但对出现脑电爆发抑制时的丙泊酚效应室浓度无明显影响。
目的:探討丙泊酚 TCI 時患者意識消失(LOC)及誘髮腦電爆髮抑製(BS)時的效應室半數有效濃度(EC50)的影響。方法擇期全痳手術患者60例,隨機均分為瑞芬太尼組(R 組)和生理鹽水組(N 組)。R 組:以4 ng/ml 靶濃度 TCI 瑞芬太尼10 min 後開始 TCI 丙泊酚,靶濃度從1μg/ml開始遞增,遞增梯度為1μg/ml,每一靶濃度輸註1 min,至腦電鑑測爆髮抑製比(BSR)達到15%後結束試驗;N 組:以等量生理鹽水模擬瑞芬太尼 TCI,其餘方法與 R 組相同,期間所有患者每間隔20秒行改良 OAA/S 評分,改良 OAA/S 評分<2分定義為 LOC,BSR>15%定義為齣現 BS 現象。記錄 LOC 和 BSR 達15%時的丙泊酚 EC50及其95%可信區間(CI)。結果LOC 時 R 組丙泊酚效應室 EC50為1.73μg/ml(95%CI 1.68~1.79μg/ml),N 組為2.35μg/ml(95%CI 2.29~2.41μg/ml)(P<0.05)。BSR 達15%時 R 組和 N 組丙泊酚 EC50分彆為6.25μg/ml (95%CI 6.18~6.42μg/ml)和6.31μg/ml(95%CI 6.13~6.47μg/ml),兩組差異無統計學意義。結論複閤 TCI 瑞芬太尼可降低丙泊酚 TCI 意識消失時的效應室 EC50,但對齣現腦電爆髮抑製時的丙泊酚效應室濃度無明顯影響。
목적:탐토병박분 TCI 시환자의식소실(LOC)급유발뇌전폭발억제(BS)시적효응실반수유효농도(EC50)적영향。방법택기전마수술환자60례,수궤균분위서분태니조(R 조)화생리염수조(N 조)。R 조:이4 ng/ml 파농도 TCI 서분태니10 min 후개시 TCI 병박분,파농도종1μg/ml개시체증,체증제도위1μg/ml,매일파농도수주1 min,지뇌전감측폭발억제비(BSR)체도15%후결속시험;N 조:이등량생리염수모의서분태니 TCI,기여방법여 R 조상동,기간소유환자매간격20초행개량 OAA/S 평분,개량 OAA/S 평분<2분정의위 LOC,BSR>15%정의위출현 BS 현상。기록 LOC 화 BSR 체15%시적병박분 EC50급기95%가신구간(CI)。결과LOC 시 R 조병박분효응실 EC50위1.73μg/ml(95%CI 1.68~1.79μg/ml),N 조위2.35μg/ml(95%CI 2.29~2.41μg/ml)(P<0.05)。BSR 체15%시 R 조화 N 조병박분 EC50분별위6.25μg/ml (95%CI 6.18~6.42μg/ml)화6.31μg/ml(95%CI 6.13~6.47μg/ml),량조차이무통계학의의。결론복합 TCI 서분태니가강저병박분 TCI 의식소실시적효응실 EC50,단대출현뇌전폭발억제시적병박분효응실농도무명현영향。
Objective To investigate the effect-site concentration for 50% of maximal effect (EC50 )of propofol required for loss of consciousness and onset of burst suppression and to assess the effect of target-control infusion(TCI)of remifentanil on these EC50 of propofol.Methods Sixty patients undergoning general anesthesia for scheduled surgery were randomly divided into 2 groups (n=30):group R received TCI of remifentanil with a target concentraton of 4 ng/ml 10 minutes before TCI of propofol,which started at a target plasma concentration of 1μg/ml and then increased by 1μg/ml step every 1 minute until the burst suppression ratio reach to 15%.Group N received a mock TCI of saline instead of remifentanil and the other procedures were as same as group R.During this,all patients were assessed by modified Observ-er’s Assessment of Alertness/Sedation (OAA/S)scale,the loss of consciousness was definited by modified OAA/S values less than 2,the onset of burst suppression was definited by 15% of burst suppression ratio. Results The EC50 of effect-site concentration of propofol required for loss of consciousness and onset of burst suppression were 2.35 (95%CI 2.29-2.41)and 6.31 (95%CI 6.13-6.47)μg/ml respectively.The EC50 of propofol required for loss of consciousness was decreased to 1.73μg/ml by TCI of remifentanil,but the EC50 of propofol required for onset of burst suppression did not changed by TCI of remifentanil. Conclusion TCI of remifentanil could decrease the EC50 of propofol effect-site concentration required for loss of consciousness but has no effect on the EC50 of propofol required for onset of burst suppression.