CAJ | 학술논문

目的：探讨静脉复合全身麻醉中瑞芬太尼、丙泊酚维持降压幅度10%时的量效关系。方法选取2010年1月~2014年1月入院的拟在全身麻醉下行剖宫产术的重度子痫前期患者100例,采用随机数字表法将其分为4组,每组25例。所有患者采用依托咪酯0.3 mg/kg、瑞芬太尼15μg/kg、阿托品0.007 mg/kg、维库溴铵0.15 mg/kg 6 min泵注维持,A、B、C、D组患者分别采用丙泊酚8、7、6、5 mg/(kg·h)恒速泵注、患者均调节瑞芬太尼60μg/(kg·h)起始,维持MAP比基础MAP降低10%。观察4组患者的MAP维持平稳指数、HR维持平稳指数、瑞芬太尼用量、停丙泊酚到睁眼时间、维持中反应熵以及全身麻醉维持效果评级,并进行统计学分析。结果4组均能达到维持MAP比基础MAP降低10%的效果,HR随MAP降低减慢；瑞芬太尼用量逐组增加。C、D组MAP维持平稳指数明显高于A、B组,停丙泊酚到睁眼时间明显短于A、B组(P<0.05)；D组全身麻醉维持效果评级明显优于其他各组(P<0.05)。结论丙泊酚5 mg/(kg·h)配合瑞芬太尼平均泵速60μg/(kg·h)是静脉复合全身麻醉控制性降压幅度10%时最佳量效关系。
목적：탐토정맥복합전신마취중서분태니、병박분유지강압폭도10%시적량효관계。방법선취2010년1월~2014년1월입원적의재전신마취하행부궁산술적중도자간전기환자100례,채용수궤수자표법장기분위4조,매조25례。소유환자채용의탁미지0.3 mg/kg、서분태니15μg/kg、아탁품0.007 mg/kg、유고추안0.15 mg/kg 6 min빙주유지,A、B、C、D조환자분별채용병박분8、7、6、5 mg/(kg·h)항속빙주、환자균조절서분태니60μg/(kg·h)기시,유지MAP비기출MAP강저10%。관찰4조환자적MAP유지평은지수、HR유지평은지수、서분태니용량、정병박분도정안시간、유지중반응적이급전신마취유지효과평급,병진행통계학분석。결과4조균능체도유지MAP비기출MAP강저10%적효과,HR수MAP강저감만；서분태니용량축조증가。C、D조MAP유지평은지수명현고우A、B조,정병박분도정안시간명현단우A、B조(P<0.05)；D조전신마취유지효과평급명현우우기타각조(P<0.05)。결론병박분5 mg/(kg·h)배합서분태니평균빙속60μg/(kg·h)시정맥복합전신마취공제성강압폭도10%시최가량효관계。
Objective To investigate the dose effect relationship of remifentanil,propofol maintaining hypotension ampli-tude for 10% in intravenous combined general anesthesia. Methods 100 cases with severe preeclampsia treated in our hospital from January 2010 to Jaunary 2014 given cesarean section under general anesthesia were selected and they were divided into four groups,and there were 25 cases in each group.All patients were given pump injection mainte-nance with 0.3 mg/kg of etomidate,15 μg/kg of remifentanil,0.007 mg/kg of atropine,0.15 mg/kg of vecuronium for 6 miniutes.Patients in group A,B,C,D was given 8,7,6,5 mg/(kg·h) of propofol for pump injection with constant speed,and remifentanil was adjusted for 60 μg/(kg·h) in the beginning,and maintaining MAP decreased by 10% compared with basic MAP.MAP remained stable index and HR remained stable index,dosage of remifentanil,the time of propofol stopped to eye opening,the reaction entropy during maintaining,and rating of maintenance effect for general anesthesia in four groups was observed respectively,and statistical analysis was conducted. Results 4 groups could reach the effect of maintaining MAP decreased by 10% compared with basic MAP,HR was slowed down along with MAP decreasing;the dosage of remifentanil increased group by group.MAP remained stable index in group C and D was significantly higher than that of group A and B respectively,the time of propofol stopped to eye opening in group C and D was significantly shorter than that of group A and B (P<0.05);rating of maintenance effect for general anesthesia in group D was superior to that of other groups (P<0.05). Conclusion Propofol of 5 mg/(kg·h) with remifentanil 60μg/(kg·h) with average pump speed is the best relationship between dosage and effect of intravenous combined general anesthesia for controlling the antihypertensive amplitude for 10%.