舒芬太尼联合丙泊酚靶控输注用于肝功能不全患者麻醉诱导的观察

目的评价舒芬太尼联合丙泊酚靶控输注用于肝功能不全患者麻醉诱导的可行性和安全性,探讨更适合的舒芬太尼浓度,以及不同浓度舒芬太尼对丙泊酚药效学的影响。方法选择ASAⅡ～Ⅲ级,ChildB级,择期行脾切除门奇静脉断流术的患者30例。麻醉诱导靶控输注舒芬太尼Ce分别为L组（0.6μg/L）和H组（0.8μg/L）,达到设定值时开始靶控输注丙泊酚。当患者意识消失时将预设丙泊酚血浆浓度调低并使其效应室靶浓度高于意识消失时浓度,同时静脉注射罗库溴胺0.9mg/kg完成气管插管,机械通气。记录不同时点观察值。结果诱导时L组患者心率及血压无明显波动。H组舒芬太尼Ce值达到0.8μg/L时,血压比基础值升高4.2%（P〈0.05）,3例患者出现呼吸抑制,4例患者出现肌肉僵直（P〈0.05）。两组BIS值在舒芬太尼输注前后变化无显著性差异（P〉0.05）。意识消失时L、H组的丙泊酚Ce值分别为（1.84±0.54）mg/L、（1.32±0.37）mg/L（P〈0.01）,丙泊酚用量分别为（62.24±6.03）mg、（39.83±5.64）mg（P〈0.01）,BIS值分别为67±11、70±11（P〉0.05）。结论舒芬太尼Ce值为0.6μg/L,联合丙泊酚靶控输注麻醉诱导用于肝功能不全患者,血流动力学更为平稳,应激反应小,无呼吸抑制及肌肉僵直,相对具有可行性和安全性。舒芬太尼Ce值分别为0.6μg/L、0.8μg/L靶控输注不会引起BIS值显著变化,而与丙泊酚联合使用时具有协同作用,可降低意识消失时丙泊酚的Ce值。

Sufentanil combined with propofol by target-controlled infusion for patients with liver dysfunction during induction of anesthesia

Objective To evaluate the feasibility and safety of target-controlled infusion of sufentanil combined with propofol for patients with liver dysfunction during induction of anesthesia,to explore suitable sufentanil concentration,as well as the effect of different concentrations of sufentanil on pharmacodynamics of propofol to target-controlled infusion （TCI）.Methods Thirty patiens were recruited in the study,who were ASA physical status Ⅱ～Ⅲ and child-B undergoing splenectomy plus porta-azygosdisconnection.Candidates were dicided into two groups the concentrations of Sufentanil,which were target-controlled infusion with Ce value at 0.6 μg/L （L group） and 0.8 μg/L （H group） during induction of anesthesia.Target-controlled infusion of Propofol started when the Ce of sufentanil reached.When patients lost their awareness,the Cp of propofol was adjusted lower which would make Ce higher than Ce of unawareness.At the same time the tracheal intubation was facilited with rocuronium 0.9mg/kg.Record the value of different times.Results In L group there were no obvious fluctuations in HR and MAP.The MAP rised 4.2% than the basic value in H group when Ce value of sufentanil reached 0.8 μg/L （P 0.05）.Three cases of respiratory depression ventilatory and four cases of muscular stiffness could be observed in H group,the difference bentween L and H group was signigicant （P 0.05）.In both groups,the BIS value did not change significant before and after infusion of sufentanil （P 0.05）.There were singnificant differences in Ce of Propofol between two groups [（1.84±0.54） mg/L and （1.32±0.37）mg/L in group L and H,respectively]at the time of unconciousness （P 0.01）.There were singnificant differences in dosages of Propofol between two groups [（62.24±6.03） mg and （39.83±5.64）mg in group L and H,respectively] at the time of unconciousness （P 0.01）,but BIS values between two groups had no statistical differences （P 0.05）.Conclusions The hemodynamics are stable and intubation stress reaction is mild when TCI of suffentanil （Ce 0.6μg/L） combined with propofol for patients with liver dysfunction during induction of anesthesia.There are no singnificant side effects,such as respiratory depression and muscular stiffness,which indicates this method is feasible and safe.The BIS value can not be changed by TCI of Sufentanil at Ce 0.6μg/L and 0.8μg/L but the Ce value of propofol can be reduced with the use of propofol combined with the sufentanil.