老年患者全麻诱导期丙泊酚和瑞芬太尼联合靶控输注的最佳复合浓度

 目的 探讨老年患者全麻诱导期丙泊酚和瑞芬太尼联合靶控输注的最佳复合浓度。方法 将50名年龄在65~75岁之间的患者随机分为5组：A、B、C、D、E组，瑞芬太尼效应室浓度分别设为:0、2、4、6、8 ng/mL。丙泊酚效应室药物浓度由2 μg/mL开始，每2 min追加1 μg/mL至脑电双频指数（bispectral index，BIS）稳定于（40±5）。监测诱导期间不同时间点瑞芬太尼血浆和效应室浓度、丙泊酚血浆和效应室浓度、心率、有创血压、BIS、听觉诱发电位和体动反应，经统计分析，进行最佳复合浓度判断。结果 诱导期间，各组间高血压和低血压发生比例具有显著性差异（P<0.05），B组血流动力学最平稳，分别为20%和10%。意识消失时，丙泊酚和瑞芬太尼效应浓度存在负相关性。气管插管即刻，B组体动反应和血流动力学变化最小。结论 瑞芬太尼复合丙泊酚联合靶控输注可安全用于老年患者全麻诱导，瑞芬太尼效应室浓度为2 ng/mL时血流动力学最平稳：意识消失时，丙泊酚效应室浓度为（3.5±0.8）μg/mL；气管插管时，丙泊酚效应室浓度为5.3 μg/mL。

Clinical study of target-controlled infusion of propofol and remifentanil in elderly patients during the induction of general anesthesia

Objective To study the best multiple concentration of target controlled infusion of propofol and remifentanil in elderly patients during the induction of general anesthesia. Methods Fifty elderly patients were randomized into five groups, according to the effect site concentration of remifentanil (0, 2, 4, 6, 8 ng/mL). We started the effect site concentration of propofol (PEC) at 2 μg/mL, and added 1 μg/mL every 2 min until bispectral index (BIS) was stable at 40±5. During the induction,we recorded the effect site concentration of remifentanil (REC) and propofol (PEC), heart rate (HR), arterial blood pressure (ABP), BIS, AAI, and isolated forearm technique (IFT). After statistic analysis, the best multiple concentration was judged. Results There was no significant difference (P<0.05) in the changes of hypertension and hypotension among these five groups during intubation. The most smooth hemodynamic conditions were found in group B, i.e. 20% and 10%, respectively. When consciousness was lost, there was a negative correlation between PEC and REC. Group B was the minimum on the change of IFT and the cardiovascular system among these five groups at tracheal intubation. Conclusions It is safe and stable to use REC 2 μg/mL for TCI, combined with propofol in elderly patients under general anesthesia. PEC is (3.5±0.8)μg/mL when the patients' consciousness is lost. And PEC is 5.3 μg/mL at tracheal intubation.