丙泊酚联合舒芬太尼靶控输注用于冠脉搭桥手术的探讨

目的观察不同浓度舒芬太尼联合丙泊酚靶控输注（TCI）用于冠脉搭桥手术的最佳剂量选择。方法选择行冠脉搭桥手术患者36例（ASAⅠ～Ⅲ级）,随机分为A、B、C 3组,每组12例,分别靶控输注舒芬太尼0.5,1.0,1.5μg/L和丙泊酚0.5～2.0 mg/L,使脑电双频指数（BIS）保持在40～60范围内。劈胸骨后舒芬太尼靶浓度减少1/4。观察3组患者MAP、HR和丙泊酚用量的变化以及丙泊酚Ce改变的次数。结果相对于诱导前（T1）,A组患者在劈胸骨时HR和MAP值（T4）显著升高（P〈0.05）;相对于A组,C组在插管时（T3）MAP值显著下降（P〈0.05）,B组和C组在劈胸骨时HR和MAP值显著降低（P〈0.05）。B组和C组的丙泊酚用量和丙泊酚Ce改变次数显著少于A组（P〈0.05）。结论靶控输注高浓度舒芬太尼（舒芬太尼靶浓度≥1.0μg/L）联合丙泊酚用于冠脉搭桥手术,血流动力学更稳定,并能减少丙泊酚的用量和丙泊酚Ce改变次数。

Efficacy and Safety of Target Controlled Infusion of Sufentanil and Propofol in Coronary Artery Bypass Graft Surgery

Objective To investigate optimized selection of different concentrations sufentanil and propofol in coronary artery bypass graft surgery（CABG）.Methods Thirty-six patients undergoing CABG surgery（ASA Ⅰ-Ⅲ） were randomly assigned to three groups（A,B and C group,n=12）.Sufentanil 0.5,1.0 and 1.5 μg/L and propofol 0.5-2.0 mg/L were administrated respectively by target controlled infusion（TCI） technique holding bispectral index（BIS） at the range of 40-60,sulfentanil effect-site concentrations（Ce） decreased one fourth after splitting the breast bone.Changes of mean arterial pressure（MAP）,heart rate（HR） and cumulative propofol doses and number of changes of propofol Ce during surgery were observed.Results Compared with before induction（T1）,both MAP and HR significantly increased at the time of sternotomy in group A（P0.05）.Compared with group A,MAP markedly decreased at the time tracheal intubation（T3） in group C（P0.05） and both MAP and HR significantly declined at the time sternotomy in group B and C（P0.05）.Cumulative propofol doses and number of changes of propofol Ce were significantly lower in group B and C than those in group A（P0.05）.Conclusion High concentration sufentanil（sufentanil Ce1.0 μg/L） and propofol ejected by TCI technique in CABG could obtain more stable hemodynamics and decrease cumulative propofol doses and number of changes of propofol Ce.