瑞芬太尼或不同剂量地佐辛全麻诱导期喉罩置入对丙泊酚半数有效血浆靶浓度的影响

目的:探讨瑞芬太尼或不同剂量地佐辛全麻诱导期喉罩置入对丙泊酚半数有效血浆靶浓度（Cp50）的影响。方法:择期手术全身麻醉患者160例，随机分为A、B、C、D组各40例。A组患者初始靶控输注丙泊酚5 μg/mL，B、C和D组患者初始靶控输注丙泊酚3 μg/mL，同时，B组患者靶控输注瑞芬太尼2 ng/mL，C组患者予地佐辛0.1 mg/kg，D组患者地佐辛0.15 mg/kg，A组患者给予与B组等量0.9%氯化钠注射液。20 min后置入喉罩。记录麻醉诱导前、喉罩置入前、喉罩置入时4组患者的心率（HR）、平均动脉压（MAP）和脑电双频谱指数值（BIS）。并采取上下交叉法对丙泊酚Cp50进行观察。结果:喉罩置入前，A、C和D组患者HR均显著高于B组（P<0.01），而C组患者HR也明显高于A和D组（P<0.01）；B、C和D组患者的MAP显著高于A组（P<0.01）。喉罩置入时，B和D组患者HR均显著低于A和C组（P<0.01）。喉罩置入前与麻醉诱导前比较，A、B和D组患者HR均显著下降（P<0.01），4组患者的MAP及BIS均显著降低（P<0.01）。喉罩置入时与喉罩置入前比较，A和B组患者的HR、MAP及BIS值均上升（P<0.05～P<0.01）。C组患者MAP和BIS值亦均上升（P<0.05）。B、C和D组丙泊酚Cp50均显著低于A组（P<0.01）。且B和D组也显著低于C组（P<0.01）。结论:瑞芬太尼或地佐辛0.15 mg/kg能有效地降低丙泊酚Cp50，但地佐辛在麻醉诱导及喉罩置入过程中，血流动力学较瑞芬太尼更加稳定。

Effect of the laryngeal mask insertion during the induction of general anesthesia with remifentanil or different doses of dezocine on the half-effective target plasma concentration of propofol

Objective:To explore the effects of the laryngeal mask insertion during the induction of general anesthesia with remifentanil or different doses of dezocine on the half-effective target plasma concentration(Cp50) of propofol. Methods:One hundred and sixty patients scheduled by operation with general anesthesia were randomly divided into the group A,B,C and D(40 cases each group) . The group B,C and D were treated with initial target controlled infusion of 3 μg/mL propofol,and group A were treated with initial target controlled infusion of 5 μg/mL propofol. The group B, C and D were treated with target controlled infusion of 2 ng/ml remifentanil,0. 1 mg/kg dezocine and 0. 15 mg/kg dezocine, respectively, and the group A were the same volume 0. 9% sodium chloride injection. Laryngeal mask were placed after 20 minutes. The heart rate(HR),mean arterial pressure(MAP) and bispectral index(BIS) in all patients before induction of anesthesia,before laryngeal mask placing and at the time of laryngeal mask placement were recorded,and the propofol Cp50 were measured using the upper and lower cross method. Results:Before laryngeal mask,the HR in group A,C and D were significantly higher than that in group B(P<0. 01),the HR in group C was significantly higher than that in group A and D(P<0. 01),and the MAP in group B,C and D were significantly higher than that in group A(P<0. 01). At the time of laryngeal mask placement,the HR in group B and D were significantly lower than that in group A and C(P<0. 01). Compared with that of before induction of anesthesia,the HR in group B,C and D decreased significantly(P<0. 01),and the MAP and BIS in all groups decreased significantly before laryngeal mask placing(P<0. 01). Compared with that of before laryngeal mask placing,the HR,MAP and BIS in group A and B increased(P<0. 05 to P<0. 01),the MAP and BIS in group C increased(P<0. 05),propofol Cp50 in groups B,C and D were significantly lower than that in group A(P<0. 05),and propofol Cp50 in groups B and D were significantly lower than that in group C at the time of laryngeal mask placing(P<0. 01). Conclusions:Remifentanil or 0. 15 mg/kg dezocine can effective reduce the effective dose of propofol Cp50,but the dezocine in hemodynamics is more stable than that of remifentanil during the induction of general anesthesia and laryngeal mask.