摘要
目的评价靶控输注依托咪酯复合瑞芬太尼用于支气管超声引导内镜针吸活检术的效果。方法择期拟行支气管超声引导内镜针吸活检术患者69例，ASA分级I或Ⅱ级，性别不限，年龄35．71岁，体重41～83kg，采用随机数字表法，将患者随机分为3组（n=23），I组麻醉诱导采用靶控输注异丙酚，血浆靶浓度3—4ug／ml，静脉注射芬太尼4ug／ml；11组麻醉诱导采用靶控输注异丙酚，血浆靶浓度3～4ug／ml，靶控输注瑞芬太尼，血浆靶浓度5ng／ml；III组麻醉诱导采用靶控输注依托咪酯，血浆靶浓度0．3—0．4ug／ml，靶控输注瑞芬太尼，血浆靶浓度5ng/ml。待患者意识消失后置入喉罩，行机械通气，维持P。ET CO2 30—40mmHg。术中维持BIS值40—60。记录术中血管活性药物（佩尔地平、麻黄碱、阿托品和艾司洛尔）使用情况、呛咳发生情况、苏醒时间、术后24h恶心呕吐发生情况。于麻醉诱导前30min、术毕即刻和术后24h，采集股静脉血样，采用放射免疫法测定血浆皮质醇浓度。结果与I组比较，Ⅱ组和Ⅲ组呛咳和恶心呕吐的发生率降低，苏醒时间缩短，Ⅲ组血管活性药使用率降低（P〈0．05）；与Ⅱ组比较，Ⅲ组血管活性药物使用率降低（P〈0．05）。与I组和Ⅱ组比较，Ⅲ组术毕时血浆皮质醇浓度降低（P〈0．05）；I组和Ⅱ组间各时点血浆皮质醇浓度差异无统计学意义（P〉0．05）。结论靶控输注依托眯酯（血浆靶浓度0．3～0．4ug／ml）复合瑞芬太尼（血浆靶浓度5ng／ml）用于支气管超声引导内镜针吸活检术的麻醉效果好，不良反应少。
Objective To investigate the effectiveness of target-controlled infusion （TCI） of etomidate and remifentanil for endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） . Methods Sixtynine ASA I or II patients of both sexes, aged 35-71 yr, weighing 41-83 kg, scheduled for elective EBUS-TB- NA, were randomly divided into 3 groups （ n = 23 each）. In group I , anesthesia was induced with TCI of propofol and iv injection of fentanyl 4ug/ml, and the target plasma concentration （Cp） of propofol was set at 3-4 ug/ml. In group II , anesthesia was induced with TCI of propofol （Cp 3-4 ug/ml） and remifentanil （Cp 5 ng/ml）. In group III , anesthesia was induced with TCI of etomidate （Cp 0.3-0.4 ug/ml） and remifentanil （Cp 5 ng/ml）. After the patients lost consciousness, laryngeal mask airway was inserted to perform mechanical ventilation. PETCO2 was ma- intained at 30-40 mm Hg. BIS value was maintained at 40-60. The use of vasoactive agents （perdipine, ephedrine, atropine and esmolol） and occurrence of bucking during operation, emergence time, and the occurrence of nausea and vomiting within 24 h after operation were recorded. Blood samples were collected from the femoral vein at 30 min before induction, at the end of operation and at 24 h after operation for determination of the plasma corti- sol concentration.Results The incidence of bucking and nausea and vomiting was significantly lower, the emergence time was siguificantly shorter, and the number of patients who needed vasoactive agents during operation was significantly smaller in groups II and III than in group I （ P 〈 0.05）. The number of patients who needed vasoactive agents during operation was significantly smaller in group III than in group II （ P 〈 0.05）. Compared with groups I and II , the plasma cortisol concentration was significantly decreased at the end of operation in group III （ P 〈 0.05）. There was no significant difference in the plasma cortisol concentration at each time point between groups I and II （P 〉 0.05 ）. Conclusion TCI of etomidate （Cp 0.3-0.4 ug/ml） and remifentanil （Cp 5 ng/ml） can provide satisfactory anesthesia for EBUS-TBNA with few adverse effects.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第3期317-319,共3页
Chinese Journal of Anesthesiology
