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等效镇痛剂量舒芬太尼和瑞芬太尼呼吸抑制作用的比较
引用本文:董佳,王保国.等效镇痛剂量舒芬太尼和瑞芬太尼呼吸抑制作用的比较[J].中国医师进修杂志,2010,33(33).
作者姓名:董佳  王保国
作者单位:1. 首都医科大学附属北京天坛医院麻醉科,100050
2. 北京三博脑科医院麻醉科
摘    要:目的 观察有无普鲁泊福镇静情况下,等效镇痛剂量的舒芬太尼和瑞芬太尼对呼吸生理各参数的影响,比较两种药物呼吸抑制作用的强弱.方法 选择80例择期神经外科手术患者,按随机数字表法分为单纯舒芬太尼组(S组)和舒芬太尼联合普鲁泊福组(SP组)及单纯瑞芬太尼组(R组)和瑞芬太尼联合普鲁泊福组(RP组),每组20例.观察四组呼吸频率(RR)、分钟通气量(MV)、呼气末二氧化碳分压(PETCO2)、脉搏血氧饱和度(SpO2)、平均动脉压(MAP)、心率等指标并进行警觉/镇静评分(OAA/S),直至达到指定呼吸抑制时终止舒芬太尼和瑞芬太尼靶控输注.结果 随舒芬太尼/瑞芬太尼血浆靶浓度增加,RR、MV显著降低,PETCO2显著升高.S组和SP组达呼吸抑制时的舒芬太尼效应室浓度计算值分别为(0.46±0.14)、(0.23±0.06)μg/L,R组和RP组达呼吸抑制时的瑞芬太尼效应室浓度计算值分别为(5.22±2.11)、(2.22±1.02)μg/L.结论 等效镇痛剂量舒芬太尼和瑞芬太尼靶控输注时,随血浆靶浓度增加对自主呼吸抑制的作用增加,联合普鲁泊福后更加明显,较低浓度即可抑制自主呼吸,但等效镇痛剂量舒芬太尼和瑞芬太尼呼吸抑制作用强弱未见明显差异.

关 键 词:舒芬太尼  瑞芬太尼  普鲁泊福  靶控输注  呼吸功能不全

Comparison of respiratory depression effect of equal analgesic plasma concentration of sufentanil and remifentanil
DONG Jia,WANG Bao-guo.Comparison of respiratory depression effect of equal analgesic plasma concentration of sufentanil and remifentanil[J].Chinese Journal of Postgraduates of Medicine,2010,33(33).
Authors:DONG Jia  WANG Bao-guo
Abstract:Objective To observe the respiratory depression of sufentanil and remifentanil with target-controlled infusion under propofol sedation or not, and compare the effect of respiratory depression of the two drugs. Methods Eighty patients scheduled for elective neurosurgery were allocated into four groups by random digits table: the sufentanil group (group S), the remifentanil group (group R), the combination of sufentanil and propofol group (group SP) and the combination of remifentanil and propofol group (group RP),each group was 20 cases. The respiratory rate (RR), minute ventilation (MV),partial pressure of end-tidal carbondioxide ( PETCO2), pulse oxygen saturation (SpO2), mean arterial pressure ( MAP ), heart rate (HR), observer's assessment of alertness/sedation (OAA/S) were measured and respiratory depression was defined as one of the following end points were achieved: muscle rigidity, RR < 6 beats/min, MV < 3 L/min,PETCO2 > 55 mm Hg ( 1 mm Hg = 0.133 kPa), SpO2 < 0.90 or apnea > 15 s. Results The calculated effect concentration (Ce) of sufentanil for respiratory depression were (0.46 ± 0.14) μ g/L in group S and (0.23 ±0.06) μ g/L in group SP, and Ce of remifentanil for respiratory depression were (5.22 ± 2.11 ) μ g/L in group R and (2.22 ± 1.02) μ g/L in group PP. Some respiratory parameters,such as RR,MV were decreased and PETCO2 was increased significantly as the increase of Ce. Conclusions Target-controlled infusion of equal analgesic plasma concentration of sufentanil and remifentanil can suppress spontaneous respiration significantly with the increase of plasma concentration. There will be a synergetic effect after combining with propofol, and respiratory depression will appear at lower concentration. But equal analgesic plasma concentration of the two drugs have no significant difference in the effect of respiratory depression.
Keywords:Sufentanil  Remifentanil  Propofol  Target-controlled infusion  Respiratory insufficiency
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