Two-stage analysis of pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese patients

Background Sufentanil is a suitable choice for target-controlled infusion （TCI） because of its shorter context-sensitive half-time. The current study was to estimate the pharmacokinetics of sufentanil TCI in Chinese patients using the two-stage analysis. Methods Twelve adult patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective surgery under general anesthesia were included. Anesthesia was induced with propofol, rocuronium and sufentanil administered by TCI lasting for 30 minutes, with target effect-site concentration of sufentanil 4 or 6 ng/ml. Frequent arterial blood samples （1.5 ml） were taken during and up to 24 hours after sufentanil TCI. Before the end of surgery, another arterial blood sample （1.0 ml） was drawn for the blood-gas analysis. Plasma sufentanil concentrations were determined by liquid chromatography-tandem mass spectrometry （limit of quantitation was 5 pg/ml）. The data were analyzed with the two-stage approach, linear regression and correlation analysis. Results The pharmacokinetics of sufentanil TCI were adequately described by a three-compartment model. The variables were derived as follows： the volume of central compartment （V1） was 5.4 L, volume of distribution at steady-state （Vdss） was 222.6 L, metabolic clearance （CI1） was 0.84 L/min and elimination half-life （t~/2y） was 389 minutes. Patients＇ age, gender and PaCO2 correlated significantly with the pharmacokinetic parameters. The Vdss, volume of slowly equilibrating compartment （V3） and t1/2 y increased, and rapid distribution clearance （012） decreased with increasing patient age. Male patients had larger values of Vdss, volume of rapidly equilibrating compartment （V2） and V3 than female patients. The Vdss and V3 increased with higher PaCO2 values. There were no significant correlations between the pharmacokinetic variables and body weight, height, lean body mass, plasma albumin, sufentanil dose, duration of surgery, pH or base excess of blood （BE-B）. Conclusions The pharmacokinetics of sufentanil TCI in Chinese patients can be optimally described by a three-compartment model. The pharmacokinetic analysis technique may affect the pharmacokinetic parameters and correlations.     

Clinical evaluation of target controlled infusion system for sufentanil administration

Background Sufentanil target controlled infusion （TCI） provides stable analgesia, better hemodynamic control than a bolus injection of intravenous anesthetics, anticipated recovery and improved quality of anesthesia during perioperative period. This study evaluated the accuracy and feasibility of TCI system for sufentanil at high concentrations in Chinese surgical patients. Methods Twelve low risk adult patients undergoing elective surgery under general anesthesia were included in this study. Sufentanil was administered with a specific TCI system incorporating the population pharmacokinetic data of sufentanil previously reported, using a target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI duration was 30 minutes. Frequent arterial blood samples were taken during and up to 24 hours after sufentanil TCI for determination of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry. The changes of circulatory system function during the procedure, recovery profile and adverse effects were recorded. Measured plasma sufentanil concentrations were compared with the values predicted by the TCI system. The bias （median performance error, MDPE）, precision （median absolute performance error, MDAPE） and wobble （variability of performance error） of the sufentanil TCI system were determined. Results All patients had stable cardiovascular variables during induction and maintenance of anesthesia. Time to eye opening and extubation were （5.6±1.7） minutes when TCI set to 4 ng/ml and （7.2±2.3） minutes when set to 6 ng/ml. There was no episode of agitation, muscle rigidity or intraoperative awareness. The bias （MDPE）, precision （MDAPE） and wobble of the sufentanil TCI system were -3.7%, 18.9% and 19.6% respectively during TCI, and the MDPE, MDAPE and wobble were -29.1%, 31.7% and 15.0% respectively after TCI （up to 8 hours）. Conclusions The TCI system programmed for sufentanil at 4 or 6 ng/ml was considered acceptable for clinical use in low risk Chinese surgical patients. But the relatively larger MDPE and MDAPE after TCI suggest improvements of the Dharmacokinetic model are needed.     

患者自控-靶控输注系统输注舒芬太尼的准确性评价

目的 通过测定舒芬太尼血药浓度的方法来评价患者自控-靶控输注(PC-TCI)系统的准确性。方法 选择拟行气管内全麻下择期腹部手术的患者15例(ASAⅠ～Ⅱ级),于手术麻醉期间应用PC-TCI系统输注舒芬太尼,采用酶联免疫方法(Elisa)检测其血浆舒芬太尼浓度;选择执行误差(PE)的中位数(MDPE)、PE绝对中位数(MDAPE)、分散度和摆动度作为评价其准确性的指标。结果 MDPE、MDAPE、分散度、摆动度的中位数(95%可信区间)分别为－9.5% (－12.1%～－7.3%)、10.5% (7.5%～12.2%)、－2.5%/h (－6.8%/h～4.9%/h)、17.5% (10.3%～25.6%) 。实测血药浓度与预测血药浓度呈线性相关(R2＝0.945 3)。结论 患者自控-靶控输注系统的偏离度较小,精密度较高,而分散度较小,能维持较稳定的血药浓度,适合于临床应用。     

Diprifusor靶控丙泊酚输注系统用于全凭静脉麻醉的临床研究

目的 研究Diprifusor靶控输注(TCI)系统用于全凭静脉麻醉(TIVA)的可行性及诱导、维持和苏醒期丙泊酚靶浓度(C1)的半效浓度(ED50)。方法 102例ASA Ⅰ-Ⅱ级、行全麻择期手术的患者,分为三个年龄组(n=34):A组19-45岁、B组46-64岁、C组65-88岁。术中以Diprifusor TCI系统推注丙泊酚,芬太尼、维库溴铵单次静推行TIVA。根据手术需要及患者生命体征调节Ct。每组随机抽取15例于麻醉的九个时点采用高效液相色谱法测定丙泊酚血药浓度(Cm)。结果 该TCI系统运作中位误差(MDPE)=-9.43％,绝对运作中位误差(MDAPE)=25.29％。诱导期A、B、C三组患者的丙泊酚CtED50别为3.48、2.82和2.50 μg/mL;维持期为2.39、1.96和2.01 μg/mL;苏醒期为1.02、0.90和0.79 μg/mL。除维持期B组与C组比较无显著差异外,其它各项C1ED50都随年龄增加而降低,且都有非常显著差异(P<0.01)。结论 Diprifusor TCI系统用于TIVA的可控性和准确性较好,较之诱导期和苏醒期,维持期Ct更准确。随着年龄的增加,患者对丙泊酚的敏感性增加,所需丙泊酚Ct降低,老年患者循环系统不良反应增多。     

丙泊酚靶控输注在妇科门诊宫腔镜手术中的应用

目的探讨丙泊酚靶控输注在妇科门诊宫腔镜手术中的麻醉效果。方法选取我院收治的行门诊宫腔镜手术的患者130例并分为观察组和对照组,观察组患者65例采用丙泊酚靶控输注进行麻醉,对照组患者65例采用丙泊酚静脉注射的方式进行麻醉。结果在意识恢复时两组患者MAP、HR均显著低于麻醉前,且观察组患者的MAP和HR均高于对照组,差异有统计学意义（P〈0．05）;在T1～T2时刻,两组患者SpO2均无显著变化,差异无统计学意义（P〉0．05）;观察组患者的诱导时间稍长于对照组,但差异无统计学意义（P〉0．05）,而苏醒时间和丙泊酚用量均低于对照组,差异有统计学意义（p〈0．05）;观察组患者术中和术后的镇痛效果满意率均高于对照组,且观察组舌后坠,术后头晕及术后需吸氧的发生率显著低于对照组,差异有统计学意义（P〈0．05）。结论丙泊酚靶控输注在妇科门诊宫腔镜手术中麻醉效果好。     

舒芬太尼复合异丙酚靶控输注对单肺通气肺内分流的影响

目的:研究舒芬太尼-异丙酚靶控静脉麻醉与异氟醚麻醉对单肺通气(One-lung ventilation,OLV)肺内分流和肺顺应性(Dynamic compliance of lung,Cdyn)的影响。方法:择期行中、下段食管癌根治手术患者20例,ASAⅠ～Ⅱ级,随机分为2组(n=10):舒芬太尼-异丙酚组(SUF组),靶控输入效应室浓度为0.5 ng/ml舒芬太尼和3μg/ml异丙酚麻醉;异氟醚组(ISO组),吸入1%～3%异氟醚维持麻醉。分别于麻醉后双肺通气30 min(T0)、单肺通气30 min(T1)、60 min(T2)、90 min(T3)等4个时间点经桡动脉、颈内静脉采血做血气分析,计算肺内分流率(Qs/Qt)和Cdyn。结果:与T0时点相比,2组Qs/Qt在T1～T3时点显著增加(P<0.05),Cdyn在T1～T3时点显著降低(P<0.05);与ISO组相比,SUF组Qs/Qt在T1～T3时点降低(P<0.05),Cdyn在T1～T3时显著增加(P<0.05)。与T0时点相比,PaO2在OLV后明显下降(P<0.05),组间相比,差异无统计学意义(P>0.05)。结论:舒芬太尼-异丙酚靶...     

肝功能衰竭患者靶控输注丙泊酚的药代动力学

目的探讨肝功能衰竭患者靶控输注（target-controlled infusion,TCI）丙泊酚的药代动力学。方法9例ASAⅣ级肝功能衰竭拟行肝移植手术患者（LF组）,另以9例ASAⅠ～Ⅱ级上腹部手术患者为对照（C组）,两组均采用TCI方式输注丙泊酚,丙泊酚靶浓度为2．5μg／ml。间断采集动脉血至用药后90min止,用气相色谱-质谱（GC—MS）法检测血浆丙泊酚浓度,经计算机软件拟合,得到各项药代动力学参数。结果与对照组相比,肝功能衰竭组的中央室分布容积、外周室分布容积及清除率均升高（P〈0．05）;两组间分布半衰期和消除半衰期比较无显著性差异（P〉0．05）。结论肝功能衰竭患者丙泊酚分布容积增大,清除率升高,在相同药物剂量时,可能不会出现药物蓄积和作用时间延长。     

Concentrations of propofol in cerebral spinal fluid: target-controlled infusion

Background Although the performance of target-controlled infusion (TCI) have been studied extensively, the accuracy and safety of a TCI system that targets the effect site remains to be demonstrated. This study was to investigate the relations of TCI of propofol to its concentrations in cerebral spinal fluid (CSF), the effect-site concentrations and bispectral index (BIS).Methods Twelve mongrel dogs were used for investigations. The target effect-site concentration was set at 3 μg/ml and the infusion was lasted for 15 minutes. CSF and blood samples were then collected and propofol concentrations were determined by using high performance liquid chromatography with fluorescence detection. BIS and hemodynamic data were monitored continuously.Results The predicted plasma concentrations were generally overestimated. Median performance error (MDPE) and absolute median performance error (MDAPE) were -10.0% and 29. 9% respectively. Propofol CSF concentrations were much lower than its effect-site concentrations.Changes in BIS were consistent with propofol concentrations in CSF, both of which changed direction at 5 minutes while the effect-site concentrations relatively lagged behind. Better correlation (r^2 =0. 9195) was found between BIS and CSF concentrations, when compared with that between BIS and effect-site concentrations ( r^2 =0. 554).Conclusion With 1% enflurane inhaled, the inconsistency of drug effect to the effect-site concentrations may result from inaccuracy of pharmacokinetic parameters. CSF may show effect-site concentrations more accurately than plasma when using target effect-site concentration infusion.     

靶控输注依托咪酯意识消失的半数有效量的测定

目的 依托咪酯是一种非巴比妥类的静脉麻醉药,半衰期短.依托咪酯具有起效快、作用时间短、体内代谢迅速、恢复平稳、对心血管系统和呼吸系统抑制轻微、有脑保护的作用等特点,在临床上被麻醉医师广泛的应用.测定靶控输注依托咪酯镇静的半数有效量以及95％有效量.了解EC50(半数有效浓度)及EC95(95％有效浓度)剂量可以帮助确定依托咪酯的安全范围与有效范围;增加依托咪酯应用的安全性;提高麻醉质量与患者的舒适程度;提高合理用药.方法 选择煤炭总医院2013年1-5月择期椎管内麻醉下行下腹部或下肢手术患者41例.ASA Ⅰ ～Ⅱ级;采用靶控输注依托咪酯镇静.将其随机分为4组,靶控浓度分别为0.2 μg/ml、0.3 μg/ml、0.4 μg/ml、0.5 μg/ml观察30 min.每隔5 min记录患者警觉/镇静评分法(OAA/S)、血压、心率、呼吸次数、血气等监测指标.改良OAA/S评分为3分以上患者视为入睡.所有患者均不给术前药,同时记录药后患者镇静程度改变情况;计算靶控输注依托咪酯使患者意识消失的EC50及EC95.结果 TCI靶控输注依托咪酯的半数有效浓度为0.333 μg/ml,95％可信限为0.284～0.374 μg/ml;依托咪酯EC95为0.468μg/ml; 95％可信限为0.412～0.491 μg/ml.结论 依托咪酯靶控输注具有血流动力学稳定、对呼吸影响小,同时具有较低的肌阵挛发生率,可以广泛的应用于临床镇静和麻醉.临床推荐剂量为0.333～0.468 μg/ml.     

靶控输注舒芬太尼对大肠癌根治术患者血流动力学和应激反应的影响

目的观察靶控输注舒芬太尼和异丙酚在大肠癌根治术中的应用情况及对应激反应的影响。方法将44例择期行大肠癌根治术患者随机分为观察组与对照组,观察组共22例,以血浆浓度为靶浓度,靶控输注舒芬太尼和异丙酚;对照组共22例,靶控输注瑞芬太尼和异丙酚,观察血流动力学指标变化,检测血浆皮质醇的浓度变化并记录两组术后躁动的发生率。结果两组患者血压,心率及血浆皮质醇浓度在麻醉诱导及手术期各时点对比差异无明显统计学意义,在麻醉恢复期拔管及拔管后10min,各监测指标观察组均低于对照组,且观察组术后躁动发生率低。结论靶控输注舒芬太尼或瑞芬太尼复合异丙酚静脉全麻均适合于大肠癌根治手术患者,但舒芬太尼麻醉组在麻醉恢复期血流动力学更稳定,患者不良反应少,适合l临床应用。     

舒芬太尼和瑞芬太尼靶控输注在全麻诱导期对应激反应的影响

目的 研究比较舒芬太尼与瑞芬太尼在全麻诱导过程中对患者应激反应的影响. 方法 选择择期全麻手术患者40 例,分为舒芬太尼(S)组和瑞芬太尼(R)组,每组20例.采用分步达靶的方法 ,调节丙泊酚使脑电双频指数(BIS)保持在65以下.记录所有患者入室后(T0)、诱导后插管前即刻(T1)、插管时(T2)、插管后1 min(T3)、插管后3 min(T4)、插管后5 min(T5)、插管后10min(T6)的SBP、DBP、HR、BIS等指标,分别于T0、T3、T5、T6四个时间点采集静脉血测皮质醇及白介素-6的血清含量. 结果 两组间的 SBP、DBP、HR、BIS、皮质醇、白介素-6总体差异无统计学意义(P<0.05);各时间点间比较,麻醉诱导后两组SBP、DBP均呈下降趋势,与基础值(T0)相比差异有统计学意义(P<0.05),皮质醇先升后降,与T0相比差异有统计学意义(P<0.05),白介素-6无统计学意义(P<0.05);各时间点与组间交互效应,只有SBP有统计学意义,两组随时间变化趋势不同,R组在气管插管后5 min回落到诱导后插管前水平,S组在气管插管3 min即回落到诱导后插管前水平. 结论 舒芬太尼和瑞芬太尼通过TCI均能较好地抑制气管插管所造成的应激反应,但舒芬太尼较瑞芬太尼能更好地抑制插管引起的血压波动,维持循环系统稳定.     

丙泊酚靶控输注和间断推注在改良喉罩全麻无痛纤支镜检查中的应用

目的:比较丙泊酚靶控输注和间断推注在改良喉罩全麻纤支镜检查中的应用效果,探讨合理用药方式。方法:ASAⅠ～Ⅱ级拟行纤支镜检查病人40例,随机分为间断推注组(A组)和靶控输注组(B组),每组20例。两组病人麻醉诱导相同,置入改良喉罩后行手动辅助通气。纤支镜检查期间A组病人发生4级体动时推注丙泊酚0.5 mg/kg。B组喉罩置入后设初始血浆靶浓度3μg/ml,发生4级体动时靶浓度增加0.5μg/ml,血压<基础值20%则降低靶浓度0.5μg/ml。记录麻醉前、睫毛反射消失、置入喉罩、纤支镜过声门、入声门后5 min和检查结束各时点的MAP、HR、SpO2,同时记录诱导、唤醒及定向力恢复时间,观察4级体动发生次数、丙泊酚追加次数、呛咳、呃逆以及低氧血症等发生情况。结果:A组检查中各时点MAP和HR的波动较B组明显(P<0.05);B组的唤醒时间、定向力恢复时间较A组短,而体动、呛咳、呃逆发生率以及追加丙泊酚的次数低于A组,组间差异均有统计学意义(P<0.05)。结论:改良喉罩全麻纤支镜检查中,靶控输注丙泊酚具有血流动力学较稳定、苏醒快速、不良反应少的优点,是一种安全可行的给药方法。     

Population pharmacokinetics of rocuronium delivered by target-controlled infusion in adult patients

Background Target-controlled infusion （TCI） has been recently developed and successfully implemented in clinical practice. The current study was to estimate the population pharmacokinetics of rocuronium TCI in adult patients using nonlinear mixed-effects model （NONMEM）, and to investigate the influence of relevant factors in adult patients. Methods Fourteen ASA Ⅰ-Ⅱ patients undergoing elective laparoscopy operation with general anesthesia were included. After induction, all patients received rocuronium by TCI system. The beginning target plasma concentration （Cpt） was 2.0 μg/ml, then increased Cpt according to the neuromuscular transmission monitoring. The endpoint of Cpt was determined when the T1 scale was blocked by 90%-95%. TCI rocuronium was stopped 30 minutes before the end of the operation. Arterial blood was drawn before anesthesia at 0, 2, 4, 6, 8, 10, 15, 20, 30, 45, 60, 120, 180, 240 and 360 minutes after the infusion of rocuronium was stopped for the analysis of plasma concentrations of rocuronium by liquid chromatography-mass spectrometry/mass spectrometry （LC-MS/MS）. The population pharmacokinetics analysis was performed using NONMEM program. Results The pharmacokinetics of TCI rocuronium in adult patients was best described by a three-comparment model. Pharmacokintic parameters were clearance （CL）1=0.205 L/min, CL2=0.324 L/min, CL3=0.0292 L/min, volumes of distribution （V）1=4.00 L, V2=2.28 L, V3=4.26 L, Vdss=10.54 L. Both age and weight as covariates affected the pharmacokinetic parameters. V1 and CL1 were negatively correlated with patient age. CL1 was positively correlated with weight. Conclusions No pharmacokinetic change was noted when rocuronium was administered via TCI. Both age and weight as covariates affected the pharmacokinetic parameters.     

丙泊酚复合瑞芬太尼靶控输注用于ERCP麻醉的临床研究

目的 比较不同效应室靶浓度丙泊酚复合瑞芬太尼行内镜逆行胰胆管造影术(ERCP)的麻醉效果.方法 拟行ERCP术患者150例,ASA Ⅰ、Ⅱ级,年龄20～65岁,随机分为3组(n=50):P4.0组、P4.5组和P5.0组.ERCP术前靶控输注丙泊酚、瑞芬太尼行全凭静脉麻醉,丙泊酚效应室靶浓度分别设为4.0、4.5和5.0μg/mL,瑞芬太尼效应室靶浓度设为1.5 ng/mL,靶控输注泵显示二者效应室浓度达目标浓度时开始检查,检查结束时停止靶控输注.于麻醉诱导前(T0)、进镜时(T1)、镜至十二指肠乳头(T2)、术中(记录术中任意3次取均值)(T3)和患者清醒(T4)时监测血压(SBP/DBP)、心率(HR)、脉搏氧饱和度(SpO2)和Narcotrend麻醉深度评分(NT).记录丙泊酚与瑞芬太尼的用量、SpO2最低值、操作时间及患者苏醒时间.记录需麻黄碱静注、体动、呛咳和打鼾的患者例数.结果 3组SBP、DBP、HR和SpO2数学平均值均在正常范围内.P5.0组的打鼾患者比例最高(P＜0.05),SpO2值最低(P＜0.05),苏醒时间最长(P＜0.05).P4.0组体动和呛咳的患者比例最高(P＜0.05).3组均无出现SpO2＜85%或心率失常的不良事件.结论 丙泊酚效应室靶浓度4.5μg/mL复合瑞芬太尼1.5ng/mL靶控输注行ERCP术麻醉,安全有效.     

靶控输注静脉麻醉与静吸复合麻醉对老年患者术后认知功能影响的比较

目的 比较靶控输注丙泊酚和瑞芬太尼静脉麻醉与七氟烷和瑞芬太尼静吸复合麻醉对老年患者术后认知功能的影响.方法 选择65岁以上择期行腹部手术的老年患者60例,ASAⅠ～Ⅲ级,随机分为两组:靶控输注丙泊酚和瑞芬太尼全凭静脉麻醉组(TCI组)30例,七氟烷和瑞芬太尼静吸复合麻醉组(S组)30例.术中应用麻醉深度指数(CSI)监测镇静深度,并根据CSI值调整用药量,术后接静脉镇痛泵进行持续镇痛.记录手术后睁眼、拔管和语言应答时间等麻醉恢复指标,并于麻醉前、术后1、3、6、12和24 h采用简易智力状态检查表(MMSE)评价认知功能.结果 TCI组患者术后苏醒时间、拔管时间和拔管后语言应答时间均早于S组(P＜0.05);两组患者术前MMSE评分无差异,TCI组术后1 h和3 h评分较术前均明显下降(P＜0.05),S组患者术后1.3h和6.0 hMMSE评分较术前均明显下降(P＜0.05);S组较TCI组评分低(P＜0.05);TCI组患者MMSE评分术后6 h恢复至术前水平,而S组术后12 h恢复至术前水平.结论 靶控输注丙泊酚静脉麻醉和七氟烷静吸复合麻醉用于老年患者均可引起术后早期认知功能障碍,但TCI组较S组苏醒快,认知功能恢复早.     

丙泊酚靶控输注复合瑞芬太尼在小儿扁桃体摘除术中的应用

目的 通过与七氟醚、瑞芬太尼静吸复合麻醉时比,探讨丙泊酚TCI复合瑞芬太尼用于小儿扁桃体摘除术中的安全性和有效性.方法 30例全麻下行扁桃体摘除术的小儿,ASA Ⅰ、Ⅱ级,随机分为两组:丙泊酚TCI组(P组,n=15)和七氟醚吸入麻醉组(S组,n=15).P组采用效应室靶控输注,异丙酚靶浓度为4μ/mL;S组吸入2.5%七氟醚.观察麻醉诱导、气管插管以及手术开始时的血流动力学改变;观察术毕停药后拔管时间、拔管后10min的意识状态以及苏醒期躁动、术后恶心呕吐的发生情况.结果 P组麻醉诱导时的最低平均动脉压(MBP)低于S组(P＜0.05),插管反应发生较少;S组在手术开始后最高MBP高于P组,但差异无显著性(P＞0.05);两组术毕拔管时间差异无显著性(P＞0.05);两组患儿术后恶心呕吐、躁动的发生率都较低,但P组患儿拔管后10min的OAAS评分高于S组.结论 丙泊酚靶控榆注复合瑞芬太尼用于小儿扁桃体摘除术是一种安全、有效的麻醉方法,与七氟醚、瑞芬太尼静吸复合麻醉比较,术中血流动力学平稳、苏醒质量较好.     

右美托咪啶复合靶控输注丙泊酚用于无痛人工流产术的观察

目的探讨右美托咪啶复合靶控输注(TCI)丙泊酚用于无痛人工流产术的有效性及安全性。方法拟行无痛人工流产手术患者120例,随机分为观察组和对照组各60例。对照组患者开始以血浆靶浓度(Cp)为4~5 mg.L-1TCI丙泊酚,逐渐增加至6~7 mg.L-1,当患者睫毛反射消失时减至4~5 mg.L-1;观察组在TCI丙泊酚前缓慢静脉推注(超过5 min)右美托咪啶0.5μg.kg-1。记录术前(T1)、睫毛反射消失时(T2)、扩宫时(T3)、吸宫时(T4)和手术结束时(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)值;记录丙泊酚的总用量、诱导时间、唤醒时间和定向力恢复时间;并观察术中患者体动反应、呼吸抑制及术后宫缩痛情况。结果观察组T2、T3、T4时的HR较T1时明显减慢,差别有统计学意义(P<0.05);对照组T2、T3、T4时的MAP、SpO2均较T1时显著降低,差别有统计学意义(P<0.05)。组间比较显示,T2、T3时对照组的MAP、SpO2明显低于观察组,T2、T3、T4时对照组的HR明显高于观察组,差别有统计学意义(P<0.05);观察组的诱导时间、唤醒时间及定向力恢复时间明显比对照组缩短,丙泊酚总用量比对照组减少,差别均有统计学意义(P<0.05)。观察组的呼吸抑制、术后宫缩痛及术中体动反应发生率明显低于对照组,差别有统计学意义(P<0.05)。结论右美托咪啶0.5μg.kg-1复合TCI丙泊酚应用于无痛人工流产手术安全有效。     

靶控输注丙泊酚与联合瑞芬太尼用于无痛人工流产术的临床效果比较

目的:比较靶控输注丙泊酚及联合瑞芬太尼用于无痛人工流产(人流)术的麻醉效果及不良反应,寻找人流术合理的静脉麻醉方法。方法:80例ASAⅠ级接受无痛人流术者随机分为单纯丙泊酚靶控输注组(A组)和丙泊酚复合瑞芬太尼靶控输注组(B组),每组40例。A组患者单纯靶控输注丙泊酚,B组先以瑞芬太尼血浆浓度2μg/L输注3 min后,开始输注丙泊酚。丙泊酚初始靶浓度为2.0 mg/kg,稳定1 min后每次递增0.5~1 mg/kg直至意识消失。术中调整丙泊酚靶浓度值,维持麻醉完善,手术结束后停药。结果:麻醉效果B组优于A组(P<0.005)。B组诱导时间明显短于A组(P<0.01),B组丙泊酚总剂量明显少于A组(P<0.01)。苏醒期躁动、兴奋多语A组发生率明显高于B组(P<0.05)。两组麻醉后血压均明显下降(P<0.01),扩宫时最低,术毕恢复至麻醉前水平(P>0.05)。两组受术者满意度VAS评分差异无统计学意义(P>0.05),手术医师满意度VAS评分B组高于A组(P<0.01)。结论:在无痛人流术中,靶控输注丙泊酚复合瑞芬太尼的麻醉诱导时间短,丙泊酚用量显著减少,不良反应减少,效果优于单纯丙泊酚靶控输注,是一种安全、合理的静脉麻醉方法。     

靶控输注异丙酚配伍不同的麻醉性镇痛药用于人工流产术的比较

目的比较靶控输注异丙酚与不同的麻醉性镇痛药配伍用于人工流产术的可行性和优越性。方法选择120例进行无痛人工流产手术的病人,ASAⅠ~Ⅱ级,随机分为靶控输注异丙酚和瑞芬太尼组(R组),异丙酚和舒芬太尼组(S组),异丙酚和芬太尼组(F组)。设定异丙酚血浆靶浓度为4μg/m l,病人入睡后R组静脉推注瑞芬太尼0.2ng/kg,F组和S组分别静脉推注芬太尼1μg/kg和舒芬太尼0.1μg/kg。术中遇体动时酌情追加异丙酚。观察术中呼吸抑制情况和血流动力学变化,记录术毕患者呼之睁眼时间、听从指令时间和定向力恢复时间,评价麻醉效果。结果R组麻醉效果满意度最高,异丙酚用药量最少,为132.05±25.46mg。术毕清醒时异丙酚血浆浓度为2.01±0.47μg/m l,明显高于其他两组(P<0.05)。R组术毕各个清醒时间均短于S组和F组,有极显著差异(P<0.01)。术中血流动力学变化,R组和S组一定程度地降低MBP,对HR影响不大。同时R组呼吸抑制的情况明显比F组和S组严重,有统计学意义。结论三种方法的比较中,靶控输注异丙酚复合瑞芬太尼麻醉效果最佳,节省麻醉药用量,苏醒迅速,但要注意其对呼吸的抑制作用。