摘要
目的观察靶控输注芬太尼对应激反应的影响,探讨靶控输注芬太尼全凭静脉麻醉的可行性。方法30例全麻腹部手术病人随机分为三组,每组10例,I组和II组为芬太尼靶控输注组,效应室目标浓度分别设定为2ng/ml和4ng/ml,III组为芬太尼人工推注组,芬太尼用量为3μg/kg。分别于入室(T0)、诱导后意识消失时(T1)、气管插管即刻(T2)、插管后5min(T3)、插管后10min(T4)、切皮(T5)、探查腹腔(T6)时记录血流动力学变化,并于T0、T2、T4、T5时点取血检测血浆肾上腺素(E)、去甲肾上腺素(NE)和血糖(BG)。结果第III组病人在T1时的收缩压及平均动脉压较其他两组低(P<0.05);T2时第III组病人心率较基础值明显升高(P<0.01);三组病人的血浆E、NE、BG均在正常值范围内。结论芬太尼效应室靶控输注目标浓度2ng/ml以上即可有效的预防气管插管及切皮时的应激反应。同人工推注相比,靶控输注在循环动力学方面更加平稳。靶控输注芬太尼全凭静脉麻醉能很好的抑制应激反应,维持血液动力学稳定。
Objective To investigate the feasibility of total intravenous anesthesia using target controlled infusion of fentanyl. Methods Thirty adults ASA I and II patients scheduled for abdomen surgery under general anesthesia were randomly divided into three groups with 10 patients in each group：group I and II received fentanyl by TCI with the target effectsite concentration set at 2 ng/ml （I） and 4ng/ml （II） during induction and maintenance of anesthesia, while group III received a bolus of fentanyl 3 μg/kg during induction of anesthesia. In addition to fentanyl, anesthesia was induced with propofol 2 mg/kg and vecuronium 0.1 mg/kg and maintained with propofol infusion at 6 mg ·kg^ - 1 · h^- 1 and intermittent i. v. doses of vecuronoum. BP （SBP, DBP, MAP） , HR, SpO2 and PETCO2 were recorded before in- duction of anesthesia （ To, baseline） , at the loss of consciousness （ T1 ） , immediately after tracheal intubation （ T2 ） , 5 and 10 minutes after intubation （T3 ,T4） ,during skin incision （T5 ） and exploration of abdominal cavity （T6）. Blood samples were obtained for determination of plasma norepinephrine （ NE ） and epinephrine （E） concentrations and blood glucose （BG） at To, T2,T4 and Ts by HPLC. Results There were no significant differences in sex, age and body weight among the three groups. The SBP and MAP in group III were significantly lower than those in group I and II at T1 （P 〈 0.05 ） , The HR in group III was significantly increased at T2 compared with baseline （P 〈 0.01 ）. There were no significant changes in plasma NE, E and BG concentrations, which were all within normal range in the three groups. Conclusions The target effect site concentration of fentanyl above 2 ng/ml may attenuate the stress response to tracheal intubation and incision effectively. Fentanyl given by TCI can maintain stable hemodynamics and can be used clinically.
出处
《医学信息（手术学分册）》
2007年第5期390-392,共3页
Medical Information Operations Sciences Fascicule
关键词
靶控输注
全凭静脉麻醉
芬太尼
target controlled infusion
total intravenous anesthesia
fentanyl
