丙泊酚复合麻醉时神经外科手术患者雷米芬太尼的量效关系被引量：21

Dose-effect relationship of remifentanil used in combination with propofol in patients undergoing neurosurgery

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摘要目的探讨丙泊酚复合麻醉时神经外科手术患者雷米芬太尼的量效关系。方法择期额颞部开颅手术患者15例,先行靶控输注(TCI)丙泊酚,设定效应室靶浓度为3μg/ml,维持PETCO2为35～45mmHg,待达到丙泊酚靶浓度后开始TCI雷米芬太尼,设定效应室靶浓度分别为2、3、4、5、6、7、8ng/ml,雷米芬太尼达不同效应室浓度时给予50mA、50Hz、5s强直电刺激,记录电刺激前后BP、HR及脑电双频指数(BIS)的变化。结果随着雷米芬太尼效应室浓度的增加,BP逐渐降低,HR逐渐减慢(P<0.05或P<0.01);强直电刺激后BP升高幅度、HR加快幅度也逐渐降低(P<0.05或P<0.01)。雷米芬太尼效应室浓度达(5.13±0.92)ng/ml时,强直电刺激后MAP升高幅度<5%,95%可信区间为3.33～6.93ng/ml。与基础值比较,随着雷米芬太尼的效应室浓度逐渐增加,BIS逐渐降低(P<0.01),电刺激前后BIS无明显变化。结论随雷米芬太尼效应室浓度的增加,镇痛强度逐渐增强,电刺激-循环反应逐渐减弱;雷米芬太尼效应室浓度大于(5.13±0.92)ng/ml时,95%可信区间为3.33～6.93ng/ml,50mA强直电刺激-循环反应变化不再明显。 Objective To evaluate the dose-effect relationship of remifentanil by electrical stimulation-circulation response. Methods Fifteen patients scheduled for intracranial surgery were involved in this study. Anesthesia was provided with propofol and remifentanil using a targetcontrolled infusion（TCI） devices. Constant effect-site concentrations of 3 μg/ml propofol were maintained. Ventilation were assisted by mask to maintain PETCO2 in 35-45 mm Hg. Remifentanil was administered stepwise to reach the constant effect-site concentrations of 2, 3, 4, 5,6, 7,8 ng/ml, respectively. Heart rate（HR）, mean arterial blood pressure（MAP） and BIS were recorded before and after the electrical stimulation （50 mA, 50 Hz, 5 s） when propofol and remifentanil reached their each effect-site concentration. Results HR and MAP were decreased significantly, electrical stimulationcirculation response was weakened as increasing effect-site concentration of remifentanil. At a effectsite concentration of remifentanil greater than （5.13±0. 92） ng/ml, the increase in MAP was less than 5% after electrical stimulation（50 mA）, and the 95% confidence limits were 3.33-6.93 ng/ml. No difference in BIS was observed after electrical stimulation. Conclusion Electrical stimulation of 50 mA induced circulationresponse was weakened as increasing effect-site concentration of remifentanil. At a effect-site concentration greater than （5.13±0.92） ng/ml, the 95% confidence limits were 3.33- 6.93 ng/ml and the electrical stimulation-circulation response was unchanged.

作者李艳王保国

机构地区中国医学科学院首都医科大学附属北京天坛医院麻醉和疼痛治疗科

出处《临床麻醉学杂志》 CAS CSCD 北大核心 2009年第3期218-220,共3页 Journal of Clinical Anesthesiology

关键词雷米芬太尼丙泊酚量-效关系 Remifentanil Propofol Dose-effect relationship

分类号 R614 [医药卫生—麻醉学]

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