摘要
目的观察瑞芬太尼、异氟烷不同配伍方式静吸复合全麻在腹腔镜手术中应用的药效学。方法选择ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除术或腹腔镜卵巢囊肿切除术45例随机分为3组，每组15例。3组诱导方式均相同。麻醉维持，A组维持吸人异氟烷1．3肺泡气最低有效浓度值（minimum alveolar concentration，MAC）；B组维持吸入异氟烷0．6MAC复合瑞芬太尼血浆靶浓度4ng／L靶控输注；C组维持吸入异氟烷0．4MAC复合瑞芬太尼血浆靶浓度6ng／L靶控输注。药效学观察指标；脑电双频指数（bispeetral index，BIS）、心率变异性（heartratevariability，HRV）、平均动脉压（mean arterial pressure，MAP）、心率（heartrate，HR）及追加肌松剂时间、呼吸恢复时间、睁眼时间、气管导管拔管时间、定向力恢复时间、术后“术中知晓”随访。同时记录各组维持期吸人异氟烷的肺泡MAC。药效学观察指标进行组问比较。结果①A组BIS值气腹2min和胆囊或卵巢肿物切下时均较B、C组低，但HRV数值在气腹2min和胆囊或卵巢肿物切下时均较B、C组高；A组MAP、HR在气腹2min时高于C组，但拔管后和清醒时又较C组低。②吸入异氟烷0.6MAC伍用瑞芬太尼血浆靶浓度4ng／L，及吸入异氟烷0．4MAC伍用瑞芬太尼血浆靶浓度6ng／L在腹腔镜手术巾即可维持一定麻醉深度。③在拔管时间、睁眼时间、定向力恢复时间上，B、C组均较A组有明显缩短。结论吸入异氟烷0．6MAC伍用瑞芬太尼血浆靶浓度4ng／L，及吸入异氟烷0．4MAC伍用瑞芬太尼血浆靶浓度6ng／L麻醉应用于腹腔镜手术，既可保证术中不同刺激的麻醉深度，又可使患者术毕快速高质量清醒。瑞芬太尼4ng／L复合异氟烷0．6MAC临床应用较瑞芬太尼6ng／L复合异氟烷0．4MAC更为理想。
Objective To study pharmacodynamic changes of combined anesthesia with remifentanil at different target plasma concentrations and isoflurane at different minimal alveolar concentrations （MAC） in laparoscopic operations. Methods Forty-five patients with ASA status Ⅰ-Ⅱ, receiving selective laparoscopic cholecystectomy or laparoscopic oophorocystectomy, were included. The patients were randomly divided into three groups with 15 patients in each group. In the Group A, anesthesia was maintained with isoflurane inhalation at the MAC of 1.3 ; in the Group B, anesthesia was maintained with both isoflurane inhalation at the MAC of 0.6 and remifentanil target-controlled infusion at 4 ng/L; and in the Group C, anesthesia was maintained with both isoflurane inhalation at the MAC of 0. 4 and remifentanil target-controlled infusion at 6 ng/L. Pharmacodynamic parameters and recovery characteristics, including bispectral index （BIS）, heart rate variability （HRV）, mean arterial pressure （MAP）, heart rate （HR）, time to additional administration of n, uscle relaxants, time to the recovery of spontaneous breathing, time to eye opening, time to endotracheal extubation, time to the recovery of orientation, arid follow-up survey of “awareness during operation”, were compared among the 3 groups. Results ①The BIS value was lower in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladder or the ovarian cyst. The measures of HRV were higher in the Group A than in the Group B and C at the time of pneumoperitoneum for 2 min and removal of the gallbladder or the ovarian cyst. The measures of MAP and HR in the Group A were higher than those in the Group C at the time of pneumoperitoneum for 2 min, and were lower than those in the Group C at the time of the endotracheal extubation and the recovery of consciousness.②Either isoflurane inhalation at the MAC of 0. 6 combined with remifentanil target-controlled infusion at 4 ng/L or isoflurane inhalation at the MAC of 0.4 combined with remifentanil target-controlled infusion at 6 ng/L provided satisfactory anesthetic maintenance. ③ Significantly shorter time to endotracheal extubation, to eye opening, and to the recovery of orientation were recorded in the Group B and C than in the Group A. Conclusions Anesthesia with target-controlled infusion of remifentanil combined with inhalation of isoflurane can be used for laparoscopic surgery. Pharmarcodynamic parameters and recovery characteristics show that combined use of remifentanil infusion at 4 ng/L and isoflurane inhalation at the MAC of 0.6 provides optimal anesthetic maintenance.
出处
《中国微创外科杂志》
CSCD
2006年第2期132-136,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
瑞芬太尼
丙泊酚
麻醉深度
异氟烷
Remifentanil
Propofol
Depth of anesthesia
Isoflurane
