CAJ | 학술논문

目的：观察中青年全麻患者瑞芬太尼用量与控制性降压幅度的关系。方法选择2013年3月~2015年2月在深圳市宝安区中医院择期手术接受全麻的中青年患者共80例，全麻维持中将患者随机分为四组：维持平均动脉压(MAP)比其基础 MAP降低≤5%组(A组)、>5%~10%组(B组)、>10%~15%组(C组)、>15%~20%组(D组)，每组20例。全麻维持中泵注丙泊酚6 mg/(kg·h)恒速不变，调节瑞芬太尼用量[起始泵速60μg/(kg·h)]在手术开始后15 min内把维持MAP降低到各组的要求范围，并持续到手术结束前5 min停止用药。结果四组全麻诱导前MAP均比其基础MAP升高15%以上，组间比较差异无统计学意义(P>0.05)。固定丙泊酚6 mg/(kg·h)时，A组维持MAP比基础MAP降低(2.79±0.04)%，瑞芬太尼平均用量为(42.54±19.16)μg/(kg·h)；B组维持MAP比基础MAP降低(8.08±1.15)%，瑞芬太尼平均用量为(53.14±18.51)μg/(kg·h)；C组维持MAP比基础MAP降低(13.63±3.78)%，瑞芬太尼平均用量为(68.04±28.47)μg/(kg·h)；D组维持MAP比基础MAP降低(17.38±4.01)%，瑞芬太尼平均用量为(99.47±32.73)μg/(kg·h)；瑞芬太尼平均用量组间比较差异有统计学意义(P<0.05)。四组维持MAP平稳指数均小于其基础MAP平稳指数，组间比较差异无统计学意义(P>0.05)。降压超过基础MAP 10%以上后部分病例出现降压封顶效应，再增加瑞芬太尼用量维持MAP不再继续降低。 C组降压封顶效应发生率为(38.09±8.91)%，D组降压封顶效应发生率为(60.00±10.13)%。结论全麻诱导前MAP均高于其基础MAP。全麻维持中与一个恒定丙泊酚用量配伍，瑞芬太尼用量越大，降压幅度越大。降压幅度越大，出现降压封顶效应的发生率越大。
목적：관찰중청년전마환자서분태니용량여공제성강압폭도적관계。방법선택2013년3월~2015년2월재심수시보안구중의원택기수술접수전마적중청년환자공80례，전마유지중장환자수궤분위사조：유지평균동맥압(MAP)비기기출 MAP강저≤5%조(A조)、>5%~10%조(B조)、>10%~15%조(C조)、>15%~20%조(D조)，매조20례。전마유지중빙주병박분6 mg/(kg·h)항속불변，조절서분태니용량[기시빙속60μg/(kg·h)]재수술개시후15 min내파유지MAP강저도각조적요구범위，병지속도수술결속전5 min정지용약。결과사조전마유도전MAP균비기기출MAP승고15%이상，조간비교차이무통계학의의(P>0.05)。고정병박분6 mg/(kg·h)시，A조유지MAP비기출MAP강저(2.79±0.04)%，서분태니평균용량위(42.54±19.16)μg/(kg·h)；B조유지MAP비기출MAP강저(8.08±1.15)%，서분태니평균용량위(53.14±18.51)μg/(kg·h)；C조유지MAP비기출MAP강저(13.63±3.78)%，서분태니평균용량위(68.04±28.47)μg/(kg·h)；D조유지MAP비기출MAP강저(17.38±4.01)%，서분태니평균용량위(99.47±32.73)μg/(kg·h)；서분태니평균용량조간비교차이유통계학의의(P<0.05)。사조유지MAP평은지수균소우기기출MAP평은지수，조간비교차이무통계학의의(P>0.05)。강압초과기출MAP 10%이상후부분병례출현강압봉정효응，재증가서분태니용량유지MAP불재계속강저。 C조강압봉정효응발생솔위(38.09±8.91)%，D조강압봉정효응발생솔위(60.00±10.13)%。결론전마유도전MAP균고우기기출MAP。전마유지중여일개항정병박분용량배오，서분태니용량월대，강압폭도월대。강압폭도월대，출현강압봉정효응적발생솔월대。
Objective To observe the relationship between Remifentanil dosages and the controlled degree of anti-hy-pertension in young and middle-aged patients underwent general anesthesia. Methods Total 80 young and middle-aged patients underwent selective operation and general aesthesia in Bao’an District Hospital of Traditional Chinese Medicine from March 2013 to February 2015 were selected, during the maintenance of general anesthesia, the patients were randomly divided into four groups:maintained mean arterial pressure (MAP) was decreased by≤5% than its basic MAP (group A),>5%-10%(group B),>10%-15%(group C),>15%-20%(group D), with 20 cases in each group. During the maintenance of general anesthesia, the syringe pumps with Propofol in constant velocity of 6 mg/(kg·h) was arranged, Remifentanil dosage [initial pumping velocity was 60μg/(kg·h)] was adjusted to lower the maintained MAP value into the expected range of each group in 15 minutes after the beginning of operation, and kept such treatment till 5 minutes earlier before the end of operation, then the medication was stopped. Results Before induction of general anesthesia, the MAP in the four groups was increased more than 15% compared with its basic MAP, there were no statistically significant differences among different groups (P> 0.05). While 6 mg/(kg·h) Propofol was maintained, the main-tained MAP in group A was decreased (2.79±0.04)%compared with its basic value, with average Remifentanil dosage of (42.54±19.16) μg/(kg·h); the maintained MAP in group B was decreased (8.08±1.15)% compared with its basic MAP, with average Remifentanil dosage of (53.14±18.51) μg/(kg·h); the maintained MAP in group C was decreased (13.63±3.78)% compared with its basic MAP, with average Remifentanil dosage of (68.04±28.47)μg/(kg·h);the maintained MAP in group D was decreased (17.38±4.01)%compared with its basic MAP, with average Remifentanil dosage of (99.47±32.73) μg/(kg·h); there were statistically significant differences of average Remifentanil dosage among different groups (P < 0.05). The stationary indexes of maintained MAP in the four groups were smaller than the basic MAP stationary indexes, there were no statistically sig-nificant differences among different groups (P> 0.05). When the anti-hypertension degree was more than 10% com-pared with the basic MAP, there were ceiling effects of anti-hypertension in part of the patients, by increasing Remifentanil dosage, the maintained MAP was no longer decreased. The incidence of ceiling effects of anti-hyperten-sion in group C was (38.09±8.91)%, which in group D was (60.00±10.13)%. Conclusion Before induction of general anesthesia, the MAP in each group is higher than its basic MAP. During maintenance of general anesthesia, a constant usage of Propofol is taken as concerted application, the bigger the Remifentanil dosage is, the higher the degree of an-ti-hypertension is. The higher the degree of anti-hypertension is, the bigger the incidence of the ceiling effects for an-ti-hypertension is.