摘要
目的比较成年和老年病人瑞芬太尼复合异丙酚靶控输注(TCI)全凭静脉麻醉的效果。方法全麻下择期行骨科手术病人40例,ASAⅠ～Ⅲ级,分为Ⅰ组(＜65岁)和Ⅱ组(≥65岁),每组20例。入室后(基础值,T_1)静脉输注乳酸钠林格氏液5 ml／kg,效应室靶浓度TCI(T_2)瑞芬太尼从1．0ng／ml渐升至4．0ng／ml后启动异丙酚TCI,从1．0μg／ml血浆靶浓度渐升至4．0μg／ml(T_3),气管插管后即刻(T_4)、切皮前3 min瑞芬太尼和异丙酚靶浓度分别调整为3．0ng／ml、3．0μg／ml。记录平均动脉压(MAP)、心率(HR)、听觉诱发电位指数(AAI)、双频谱指数(BIS),不良反应发生率、辅助药物使用次数、苏醒指标、拔除气管导管后即刻(T_6)及回病房后即刻视觉模拟疼痛评分(VAS)等。结果与Ⅰ组比较,Ⅱ组T_(2,3)时BIS降低,T_(4,5)时MAP、HR降低,心动过缓发生率、麻黄碱、阿托品使用率升高(P＜0．05),不良反应发生率差异无统计学意义。LOC时Ⅰ组和Ⅱ组异丙酚血浆靶浓度分别为2．5±0．7、(1．2±0．5)μg／ml,瑞芬太尼效应室靶浓度Ⅰ组和Ⅱ组分别为3．5±0．4、(3．3±0．4)ng／ml(P＞0．05),异丙酚4μg／ml开始至LOC的时间两组分别为130±60、(82±29)s(P＜0．01),BIS分别为52±11、46±12,AAI为40±25、30±7。Ⅰ组停药至自主呼吸、指令反应恢复时间及拔管、离室时间均早于Ⅱ组(P＜0．05)。回病房后即刻VAS评分Ⅱ组低于Ⅰ组(P＜0．05)。结论瑞芬太尼复合异丙酚TCI全凭静脉麻醉可提供老年病人骨科手术满意的麻醉效应,但需密切观察血液动力学变化。
Objective To compare the effects of total intravenous anesthesia （TIVA） with remifentanil and propofol given by target-controlled infusion（TCI） between young and elderly patients. Methods Forty ASA Ⅰ - Ⅲ patients （24 male, 16 female） undergoing elective orthopedic operation were studied after written informed consent. The patients were divided into 2 groups according to the age （ n = 20 each） ： group Ⅰ 〈 65 yr and group Ⅱ ≥65 yr. After lactated Ringer＇s solution 5 ml·kg^-1 was infused and preoxygenation （T1） the target effect-site concentration of remifentanil was set at 1.0 ng·ml^-1 and increased to 4.0 ng·ml^-1 （T2） in increments of 1.0 ng·ml^-1. Then TCI of propofol was started at target plasma concentration of 1 μg · ml^ -1 which was increased to 4.0 μg · ml^ -1 （T3） in increments of 1.0 μg · ml^ -1. After tracheal intubation （T4） and before skin incision （T5 ） the target plasma concentration of remifentanil and propofol were reduced to 3.0 ng · ml^-1 and 3.0 μg · ml^ -1respectively. Anesthesia was maintained with remifentanil and propofol. MAP, HR, AAI, BIS, the incidence of adverse effects, the supplementary drugs used, emergence index, VAS score after extubation （T6） and upon arrival in the ward were recorded. Results The decrease in BIS value was significandy larger at T2 and Ts in group Ⅱ than in group Ⅰ（P 〈0.01）. The MAP and HR were higher at T4 and T5 in groupⅠ than in group Ⅱ . The incidence of bradycardia and the number of ephedrine and atropine administration were significantly higher in group Ⅱ than in group Ⅰ （ P 〈 0.05）. At loss of consciousness the target plasma concentration of propofol was （2.5 ± 0.7 ）μg· ml^-1 in group Ⅰ and （ 1.2 ± 0.5） μg· ml^-1 in group Ⅱ . The effect-site concentration of remifentanil was （3.5 ±0.4） ng· ml^-1 in group Ⅰ and （3.3 ±0.4） ng· ml^-1 in group Ⅱ .Conclusion Anesthesia with TCI of remifentanil-propofol can provide satisfactory depth of anesthesia for orthopedic operation. The incidence of adverseeffects was low and emergence from anesthesia is quick. Attention should be paid to the changes in BP and HR.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第9期777-780,共4页
Chinese Journal of Anesthesiology
