丙泊酚麻醉诱导期间舒芬太尼适宜的靶浓度值探讨

目的 观察舒芬太尼不同靶浓度复合丙泊酚全麻诱导期间意识消失及气管插管时的血流动力学变化，探讨丙泊酚麻醉诱导时舒芬太尼的适宜靶浓度。 方法 选择60例ASAⅠ～Ⅱ级择期手术患者靶控输注（TCI）舒芬太尼、丙泊酚全凭静脉麻醉，以舒芬太尼血浆靶浓度将患者随机分为0 ng/mL (Ⅰ组)、0.2 ng/mL( Ⅱ组)、0.4 ng/mL (Ⅲ组)、0.8 ng/mL (Ⅳ组) 4组，每组15例。舒芬太尼血浆浓度与效应室浓度达到平衡后开始TCI丙泊酚，丙泊酚初始靶浓度为0.50 μg/mL，每次增加0.50 μg/mL直至患者意识消失，静注顺式阿曲库铵后行气管插管。记录麻醉诱导前(T0, 基础值)、舒芬太尼达血浆-效应室平衡时(T1)、睫毛反射消失时(T2)、意识消失时(T3)、气管插管前即刻(T4)、气管插管后1 min(T5)、3 min(T6)、5 min(T7) 时SBP、DBP、HR值。 结果 与基础值比较，第Ⅰ、Ⅱ组病人在气管插管前HR、SBP、DBP均降低，插管后均升高(P<0.05 )，除第Ⅲ组病人在气管插管前SBP降低外(P<0.05 )，第Ⅲ、Ⅳ组各时点HR、SBP、DBP组内差异无统计学意义。Ⅰ组或Ⅱ组HR、SBP、DBP在气管插管前低于Ⅲ、Ⅳ组、插管后高于Ⅲ、Ⅳ组(P<0.05 )，而Ⅰ组与Ⅱ组相比各时点HR、SBP、DBP组间差异无统计学意义。麻醉诱导期间各组未见明显不良反应。结论 舒芬太尼靶浓度0.4～0.8 ng/mL复合丙泊酚全麻诱导期间血流动力学稳定，可应用于临床麻醉。

Adequate target concentration of sufentanil during induction of general anesthesia with propofol

【Abstract】 Objective　To observe the effects of sufentanil in various target plasma concentrations on hemodynamics during general anesthesia induction with propofol. Methods　Sixty ASA Ⅰ or Ⅱpatients, aged 18～63 yr, undergoing elective surgery were randomly divided into 4 groups (n=15 each) to receive target controlled infusion (TCI) sufentanil with target concentration of 0, 0.2,0.4 and 0.8ng/mL (groups Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively). While the blood-effect site concentrations of sufentanil were equilibrated and maintained constant, patients received TCI of propofol, with an initial target concentration of 0.50μg/mL, then increased 0.50μg/mL step by step until the patients unconsciousness to intubate endotracheal catheter. In every group, SBP, DBP and HR were monitored before induction (T0), equilibration of blood-effect sit concentrations of sufentanil (T1), loss of eyelash reflex (T2), loss of consciousness (T3), immediately before intubation (T4) and 1,3,5 min after intubation(T5,6,7). Results　To compare with baseline, HR、SBP and DBP in groupⅠandⅡ decreased significantly before endotracheal intubation,increased significantly after intubation yet (P<0.05 ). In addition to group Ⅲ patients with lower SBP before endotracheal intubation (P<0.05 ), HR、SBP and DBP in group Ⅲ and Ⅳ showed no significant difference at each time point. HR，SBP and DBP in group Ⅰ and Ⅱ were lower significantly before endotracheal intubation and higher significantly after intubation than those in group Ⅲ and Ⅳ(P<0.05 ).While compared with groupⅠ,there were no significant differences in the values of HR，SBP and DBP in group Ⅱ at each time point. During induction of anesthesia, there were no significant adverse reactions in each group. Conclusion　The target plasma sufentanil concentration of 0.4 to 0.8 ng/mL in the presence of propofol for induction of anesthesia both can effectively stablize the hemodynamics, and be used in clinical anesthesia.