2种剂量舒芬太尼对丙泊酚靶控麻醉血流动力学和脑电双频指数影响

目的:研究不同剂量舒芬太尼对靶控输注丙泊酚麻醉血流动力学和脑电双频指数的影响。方法:选择下腹部手术病人30例,随机分为2组,每组各15例,麻醉诱导调定丙泊酚效应部位浓度为3 mg·L~(-1),丙泊酚达到稳态效应部位浓度1 min时,依次给予维库溴铵0．1 mg·k~(-1)和2种剂量的舒芬太尼(A组0．5 μg·kg~(-1), B组1．0μg·kg~(-1))。观察2组病人血流动力学和脑电双频指数(BIS)的变化。结果:与麻醉诱导前相比,2组病人入睡时、丙泊酚达到靶控血药浓度时、丙泊酚达到靶控血药浓度1 min时的血压和BIS值均下降(P< 0．05),推注舒芬太尼后1,3,5 min以上值下降更明显,尤以B组显著。A组气管插管后1,3 min的血压及心率值较插管前升高(P<0．05),5 min降至插管前水平,B组变化不明显,2组插管前后BIS值均小于70,无不良记忆反应。结论:在抑制插管应激反应方面,舒芬太尼1μg·kg~(-1)优于0．5μg·kg~(-1),尽管插管前有比较明显的血流动力学变化,2种浓度均能使病人达到足够的麻醉深度。

A clinical study of two dosages sufentanil on relationship between bispectral index and hemodynamic changes during propofol target control infusion anesthesia induction

AIM:To study the influences of two dosages sufentanil on relationship between bispectral index and hemodynamic changes during propofol target control infusion anesthesia induction. METHODS: Thirty patients scheduled for underbelly operation were randomly divided into two groups (A and B), 15 for each. The target induction concentration of propofol was 3 mg·L~(-1) until reaching the effective stable site concentration by 1 min and then followed by administration of vecuronium bromide 0.1 mg·kg~(-1) and two dosages sufentanil (0.5 μg·kg~(-1)in A group, 1.0 μg·kg~(-1) B group). The changes of hemodynamics and bispectral index (BIS) were observed at the time points of before induction (T_0); at the time sleeping(T)s); to the propofol preconcert concentration (T_1) and standing 1 min(T_2); after given sufentanil 1 min (T_3), 3 min (T_4),5 min(T_5); and during intubation (T_i), at 1 min (T_n), 3 min (T_(i3)),and 5 min (T_(i5)) after intubation. RESULTS: The BIS and blood pressure at T_s, T_1s T_2, were significantly lower than those at T_0 (P < 0.05) and decreased continuously after intravenous injection of sufentanil, especially in group B. The blood pressure and heart rate at Tn and Ti3 raised markedly higher than those at T5 in group A (P < 0.05) and returned to the levels of T_5 at 5 min after intubation but with no obvious changes in group B. The BIS were both lower than 70 during anaesthesia induction in two groups and with no adverse reaction concerning memory. CONCLUSION: Sufentanil lμg·kg~(-1) is superior to dosage of 0.05 μg·kg~(-1) in inhibiting cardiovescular responses to tracheal intubation. Two kinds of dosage can provide enough depth of anesthesia for patients under rather obvious unstable hemodynamies before the intubation.