摘要
目的比较以不同初始血浆靶浓度(Cp)靶控输注(TCI)异丙酚复合芬太尼麻醉诱导下短小手术患者喉罩(LM)的置入条件,探讨LM置人时适宜的异丙酚Cp。方法拟行短小手术的患者45例,年龄18～60岁,随机分为3组,Ⅰ组异丙酚Cp为4μg/ml,Ⅱ组异丙酚Cp为6 μg/ml,Ⅲ组异丙酚Cp为8μg/ml,每组15例。静脉注射芬太尼3μg/kg后3 min TCI异丙酚,当效应室浓度(EC)达2.5μg/ml 时置入LM 。观察LM的置入条件:张口度、恶心、呛咳、体动及总体条件。记录EC达2.5 μg/ml时异丙酚用量、剂量及时间。记录患者静卧后5min(T1)、意识消失时(T2)、异丙酚EC达2.5μg/ml(T3)、LM置入即刻(T4)和LM置入后3 min(T5)时收缩压(SP)、舒张压(DP)、心率(HR)及BIS。结果三组T3-5时SP、DP、HR、BIS均低于T1(P<0.01)。Ⅲ组T5时SP、DP和BIS均低于Ⅰ、Ⅱ组(P<0.05或0.01)。与Ⅰ组比较,Ⅱ、Ⅲ组异丙酚EC达2.5 μg/ml时异丙酚的用量、剂量均升高、时间缩短(P<0.01);与Ⅱ组比较,Ⅲ组异丙酚EC达2.5 μg/ml时异丙酚的用量、剂量均升高、时间缩短(P<0.01)。与Ⅰ组比较, 当异丙酚EC达2.5μg/ml时,Ⅱ、Ⅲ组完全张口度的例数、无呛咳的例数、无体动、总体条件容易的例数均升高(P<0.05),Ⅱ、Ⅲ组间上述指征比较差异无统计学意义(P>0.05)。
Objective To compare the laryngeal mask insertion conditions at different plasma target concentrations (Cp) during the induction of anesthesia with target-controlled infusion (TCI) of propofol.Methods Forty-five ASA I - II patients of both sexes aged 18-60 yr, weighing 50-80 kg undergoing minor surgery in which the use of laryngeal mask (LM) was indicated were randomly divided into 3 groups ( n = 15) according to Cp of propofol set during induction of anesthesia: 4, 6 and 8 μg · ml-1 . The patients were premedicated with intramuscular scopolamine 0.3 mg. Fentanyl 3 μg·kg-1 was given i.v. . TCI of propofol was started 3 min later with Diprifusor (Graseby 3500 infusion pump). LM was inserted when the effect-site concentration (EC) of propofol reached 2.5 μg · ml -1 as displayed on the infusion pump. LM insertion conditions (mouth opening, gagling, coughing, head and limb movement, overall ease of insertion) were assessed. The total dose of propofol, insertion time, the time needed to reach EC 2.5 μg·ml-1 were recorded. SP, DP, HR and BIS value were recorded at 6 time points: baseline before induction (T1 ) , at the loss of consciousness (T2), at EC 2.5 μg · ml-1 (T3), immediately (T4), 3 min (T5) after insertion of LM. Results The SP, DP, HR and BIS value were decreasing with increasing depth of anesthesia in the 3 groups. The decrease in BP and BIS value after insertion of LM was significantly larger in group 3 (8 μg ·ml-1) than in group 1 and 2 (P < 0.05 or 0.01). The insertion conditions were significantly better in group 3 than in the other two groups. The total amount of propofol infused was significantly larger, the insertion time and the time needed to reach EC 2.5 μ·ml-1 were significantly shorter in group 3 than in the other two groups. Conclusion Induction of anesthesia with fentanyl 3 μg· kg-1 combined with TCI of propofol with Cp set at 6 μg · ml -1 is satisfactory for LM insertion in terms of cardiovascular stability and insertion conditions.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第4期245-248,共4页
Chinese Journal of Anesthesiology
