舒芬太尼自控-靶控镇痛对腰麻患者呼吸功能和镇静程度的影响

目的 研究舒芬太尼自控.靶控(PCA-TCI)镇痛对腰麻患者呼吸功能和镇静程度的影响,以评价舒芬太尼PCA-TCI的安全性. 方法 选择择期下肢手术患者60例美国麻醉学家学会(ASA)分级Ⅰ～Ⅱ级],年龄20～59岁,体重50～80 kg,随机分成3组:Ⅰ组为舒芬太尼设定靶控血浆浓度0.1μg/L,Ⅱ组为0.15μg/L,Ⅲ组为0.2 μg/L,每组20例.腰麻平面固定第10胸椎(T10)水平后,连接PCA-TCI系统输注药物.观察PCA-TCI启动前(T0)、启动后5(T1)、10(T2)、15(T3)、20(T4)、25(T5)、30(T6)、35(T7)、40(T8)、45 min(T9)各时点PCA-TCI程序预算的舒芬太尼血浆浓度(C'p)、脉搏氧饱和度(SpO2)、呼吸频率(RR)、潮气量(VT)、呼气末二氧化碳分压(PETCO2)、第1秒呼气率(FEV1%)、吸入-呼出氧浓度差(O2I-E)、顺应性环(PV环)、心率(HR)、平均动脉压(MAP)等呼吸力学和循环参数及脑电双频指数(BIS)和警觉.镇静评分(OAA/S). 结果 舒芬太尼PCA-TCI启动后,与T0比较,3组患者呼吸功能的各项指标均有不同程度的变化,其中VT增减的幅度为-10.0%～11.3%,但与T0时比较差异无统计学意义(P>0.05).Ⅰ组患者在T4和T7时RR均降低18.2%(P<0.05),而Ⅱ组则分别降低17.4%和16.0%(P<0.05),Ⅲ组患者在T7和T8时RR降低21.7%和23.1%(P<0.05).Ⅰ组和Ⅱ组FEV1%有所降低,但与T0比较,差异无统计学意义(P>0.05),而Ⅲ组则在T7和T8时分别下降15.8%和18.5%(P<0.05).Ⅰ组、Ⅱ组患者PETCO2较T0时略有升高(P>0.05),而Ⅲ组在T7和T8时分别升高17.9%和18.6%(P<0.05).Ⅲ组患者T3～T9时,BIS降低7.2%～9.8%,OAA/S评分均大于3,与T0时比较,差异有统计学意义(P<0.05),而Ⅰ组、Ⅱ组BIS与OAA/S评分无明显变化(P>0.05). 结论 舒芬太尼PCA-TCI血浆靶浓度为0.1～0.15μg/L时对患者无明显呼吸抑制,其血浆浓度达0.21μg/L时有轻度镇静作用,且10%的患者有呼吸抑制现象.舒芬太尼PCA-TCI安全有效的临床推荐血浆靶浓度为0.1～0.15μg/L.

Effects of sufentanil patient controlled analgesia-target controlled infusion on the respiratory function and sedation of patients during subarachnoid anesthesia

Objective To investigate the effects of sufentanil patient controlled analgesia-target controlled infusion (PCA-TCI)on respiratory function and sedation of patients during subarachnoid anesthesia. Methods Sixty patients,20-59 years old,50-80 kg weight,wlth ASA Ⅰ-Ⅱ ,undergoing selective operation of lower limbs, were randomly divideded into three groups ( goup Ⅰ, Ⅱ, Ⅲ, n = 20). The target plasma concentration(Cp) of sufentanil in group Ⅰ as setted at 0.1 μg/L, in group Ⅱ 0.15 μg/L and in group Ⅲ 0.2μg/L . After the segment of subarachnoid anesthesia was fixed, sufentanil was injected with PCA-TCI system C'p(calculated by the PCA-TCI programme), SpO2, RR, VT, PETCO2, FEV1%, O2I-E, PV loop, HR, MAP,BIS and OAA/S score were recorded before sufentanil PCA-TCI started(T0) and after 5(T1), 10(T2), 15(T3), 20(T4),25(T5), 30(T6),35(T7),40(T8),45 min(T9)respectively. Results The index of respiratory function changed in different degrees after sufentanil PCA-TCI started. Compared with VT at T0,the VT fluctuated within the range-10.0% all. 3% (P>0.05). RR decreased by 18.2% at T4 and T7 in group Ⅰ compared to those at T0(P<0.05). And in group Ⅱ,RR decreased by 17.4% and 16.0% respectively at T4 and T7 (P<0.05). In group Ⅲ,RR decreased by 21.7% and 23.1% at T7 and T8 respectively(P <0.05). FEV1% decreased a little in group Ⅰ and Ⅱ,but the difference was not significant as compared to those at T0. And in group Ⅲ, FEV1% decreased by 15.8% and 18.5% respectively(P<0.05). PETCO2 increased a little in group Ⅰ and Ⅱ (P>0.05), but increased by 17.9% and 18.6% at T7 and T8 respectively in group Ⅲ (P<0.05). The BIS decreased from 7.2% to 9.8% at T3 to T9 in group Ⅲ,with OAA/S score exceeded 3. Therre were significant differences as compared with T0 (P<0.05), while BIS value and OAA/S score changed little in group Ⅰ and Ⅱ (P>0.05) . Conclusions The setted target Cp of sufentanil PCA-TCI (0. 1-0. 15 μg/L) does not produce respiratory depression obviously. When C'p of sufentanil reaches at 0. 21 μg/L,it then produces conscious sedation effect,and some patients(10%) appeared respiratory depression. The recommending effective and safe doses of setted target Cp of sufentanil PCA-TCI is (0. 1-0. 15 μg/L) clinically.