摘要
目的探讨心脏瓣膜置换术患者靶控输注（TCI）不同靶浓度瑞芬太尼复合异丙酚麻醉的效果。方法择期行心脏瓣膜置换术的风湿性心脏病患者40例,心功能Ⅱ级或Ⅲ级,随机分为2组（n=20）：低浓度瑞芬太尼复合异丙酚组（L组）和高浓度瑞芬太尼复合异丙酚组（H组）。静脉注射不同剂量瑞芬太尼复合异丙酚进行麻醉诱导,术中调节异丙酚血浆靶浓度,维持脑电双频指数40～60,L组瑞芬太尼效应室靶浓度（Ce）为4～8 ng/ml,CPB期间维持Ce 2ng/ml;H组瑞芬太尼Ce为8～12 ng/ml,CPB期间维持Ce 4ng/ml。记录心率、收缩压、舒张压、血管活性药应用及术后恢复情况,测定麻醉诱导前即刻、劈胸骨后5min、心脏复跳后5min和术毕时血浆肾上腺素、去甲肾上腺素和皮质醇浓度。结果2组术中循环稳定,血管活性药使用率差异无统计学意义（P〉0.05）,两组未发生术中知晓,术后无明显低血压和恶性心律失常发生,所有患者痊愈出院。与L组比较,H组切皮前和CPB前心率减慢（P〈0.05）,劈胸骨后5min血浆肾上腺素、去甲肾上腺素和异丙酚靶浓度较低,术中异丙酚总用量减少（P〈0.05）。结论心脏瓣膜置换术患者TCI瑞芬太尼复合异丙酚麻醉时,当瑞芬太尼Ce为4～12ng/ml时,血液动力学稳定,术后恢复好;Ce为8～12ng/ml时可减少异丙酚用量,减轻CPB前应激反应。
Objective To investigate the efficacy of target-controlled infusion （TCI） of remifentanil at different target effect-site concentrations （Ce） combined with propofol in patients undergoing elective cardiac valve replacement.Methods Forty ASAⅡorⅢpatients （NYHA gradeⅡorⅢ） aged 32-64 yr,weighing 45-78 kg were randomly divided into 2 groups （n=20 each）：groupⅠTCI of remifentanil at low Ce＋propofol （L） and groupⅡTCI of remifentanil at high Ce＋propofol （H）.The patients were premedieated with intramuscular morphine 10 mg and scopolamine 0.3 mg.Left radial artery and right internal jugular vein were cannulated.ECG, SpO2,BP,CVP and BIS were continuously monitored.Anesthesia was induced with TCI of propofol.The target plasma concentration was initially set at 0.5μg/ml and increased in increments of 0.3μg/ml until BIS value was reduced to〈65.Then a bolus of remifentanil 3μg/kg （group L） or 6μg/kg （group H） was given.Tracheal intubation was facilitated with pipecuronium 0.1 mg/kg.The patients were mechanically ventilated.BIS was maintained at 40-60 by TCI of propofol.TCI of remifentanil was started at 1 min before skin incision at Ce of 4-8 ng/ml （in group L） or 8-12 ng/ml （in group H）.SP,DP,HR,the amount of vaso-active drugs used and postoperative recovery were recorded.Results The patients were hemodynamically stable throughout the pcrioperative period in both groups.There was no significant difference in the amount of inotropic drugs consumed between the two groups.Intraoperative awareness did not occur in both groups and no patient developed significant hypotension and malignant arrhythmia after operation.All patients recovered uneventfully and discharged.The HR was significantly lower before skin incision and in the pre-bypass period in group H than in group L （P〈0.05）. The plasma epinephrine and nor-epinephrine concentrations and the target plasma concentration of propofol were significantly lower at 5 min after sternotomy in group H than in group L.Th
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第12期1067-1070,共4页
Chinese Journal of Anesthesiology
关键词
二异丙酚
哌啶类
药物释放系统
心脏瓣膜假体植入
Propofol
Piperidines
Durg delivery systems
Heart valve prosthesis implantation
