瑞芬太尼复合丙泊酚靶控输注对血液动力学及BIS的影响

目的 比较不同血浆靶浓度的瑞芬太尼复合丙泊酚靶控输注诱导对血液动力学和BIS的影响.方法 100例择期全麻手术病人按瑞芬太尼血浆靶浓度随机分为5组（R0、R1、R2、R3、R4组）即0 ng/mL、1 ng/mL、2 ng/mL、3 ng/mL、4 ng/mL组,每组20例.麻醉诱导时丙泊酚血浆靶浓度从1μg/mL开始,每2min观察一次OAA/S评分,如OAA/S评分未达到0分,则每次将丙泊酚浓度增加1μg/mL;当病人OAA/S评分达0级时,则静注维库溴铵0.1 mg/kg完成气管插管.结果 麻醉诱导后,各组病人的MAP均降低,R0、R1和R2三组病人在气管插管后MAP升高,其升高幅度较R3和R4组差异有显著性（P＜0.05）.各组病人的HR在气管插管后均增快,R0、R1和R2三组差异有显著性（P ＜0.05）；BIS值随OAA/S评分降低而降低,气管插管后R0、R1和R2组BIS值明显升高（P＜0.05）.结论 瑞芬太尼复合丙泊酚靶控输注诱导时具有协同作用,而以瑞芬太尼血浆靶浓度3 ng/mL诱导时血流动力学最稳定.

Effect of Remifentanil and Propofol Given by TCI for Induction of Anesthesia on Bispectral Index and Hemodynamics

Objective To investigate the effects of target-controlled infusion （TCI） ofremifentanil in various doses in combination of TCI propofol on bispectral index and hemodynamics. Methods One hundred ASA I - II patients undergoing elective surgery under general anesthesia were enrolled in this study. The patients were randomized to receive remifentanil at a fixed target plasma concentration of 0, 1, 2, 3 or 4 ng/mL （group R0, R1, R2, R3, R4）. TCI propofol was started at a target plasma concentration of 1/~g/mL. If the OAA/S of patients were not zero points, target propofol concentration was increased by 1/~g/mL every 2 min until loss of conciousnrss. Trachea was then intubated following intravenous vocuronium. The changes of blood pressure, heart rate and bispectral index were recorded and analyzed. Results MAP decreased significantly for 2 min after intubation in group R0, R1 and R2 （P 〈0.05）. HR increased significantly after intubation in group R0, RI and R2 （P 〈0.05）. The BIS decreased significantly following the sedation score, BIS increased significantly after intubation in group R0, R1 and R2 （P 〈0.05）. Conclusions Remifentanil potentiates propofol when given by TCI for induction of anesthesia. The target plasma remifentanil concentration of 3 ng/mL can be applied effectively and safely.