摘要
目的观察不同剂量芬太尼对异丙酚靶控输注(TCI)全麻诱导时药效学的影响。方法全麻患者84例,按芬太尼不同诱导剂量随机分成芬太尼2、4、6、8μg/kg组。麻醉诱导:静脉注射不同剂量芬太尼,靶控输注异丙酚,当(脑电双频谱指数)BIS达到(45±5)时静脉注射维库溴铵0.1mg/kg4min后气管插管、机械通气。观察麻醉前(T0)、静注芬太尼4min后(T1)、意识消失时(T2)、BIS数值降至(45±5)时(T3)、气管插管即刻(T4)、插管后3min(T5)、插管后5min(T6)时收缩压(SP)、心率(HR)、BIS值和T2、T3时异丙酚的靶控输注浓度(Ce)值和用药剂量。同时记录T1～T2(T1～2)、T1～T3(T1～3)的时间及麻醉期间不良事件发生率和气管插管反应发生情况。结果在T2、T3时芬太尼4、6、8μg/kg组患者所需异丙酚Ce、用药剂量、所需时间均较芬太尼2μg/kg组低(P<0.05);T2时,T1～2时间和用药剂量在6μg/kg组较4μg/kg组减少(P<0.05);T3时,T1～3时间和用药剂量在6μg/kg组和4μg/kg组比较差异无统计学意义(P>0.05);气管插管反应发生率芬太尼2μg/kg组较其它3组高(P<0.05),心动过缓/呛咳反应的发生率6、8μg/kg组较2、4μg/kg组高(P<0.05)。结论4种剂量的芬太尼都能增强异丙酚的镇静作用,减少麻醉诱导时间,其中4μg/kg麻醉诱导时芬太尼的协同作用较为明显且循环稳定。
Objective To investigate the effects of different doses of fentanyl on the pharmacodynamics during combined with target controled infusion（TCI）of propofol anesthesia induction and appropriate dose of fentanyl and the target effect-site concentration of TCI propofol.Methods Eighty four patients with general anesthesia were enrolled,and were divided into 4 groups according to different induction doses of fentanyl：fentanyl 2,4,6,8 μg/kg.Anesthesia was induced with iv injection of fentanyl 2,4,6 and 8 μg/kg within 1 min,TCI of propofol.Tracheal intubation was facilitated with vecuronium 0.1 mg/kg iv when BIS decreased to（45±5）.The patients were mechanically ventilated.Systolic pressure（SP）,heart rate（HR）,Bispectral index（BIS）were recorded before induction of anesthesia（T0）,at 4 min after injection of fentanyl（T1）,lost of consciouse（T2）,the BIS decreased to（45±5）（T3）,immediately（T4）and at 3 min（T5）,5 min（T6）after tracheal intubation.The Ce and consumption of propofol at T2,T3,the time from T1 to T2（T1-2）,T1 to T3（T1-3）and the devise cardiovascular events were also recorded.Results The Ce,consumption of propofol at T2 and T3 and the time T1-2,T1-3 were significantly smaller in the groups of fentanyl 4,6,8 μg/kg than 2 μg/kg.The consumption of propofol and the time T1-2 at T2 were significantly smaller in the groups of fentanyl 6 μg/kg than 4 μg/kg（P〈0.05）.The consumption of propofol and the time T1-3 at T3 were no differences between the groups of fentanyl 4 μg/kg and 6 μg/kg（P〉0.05）.The incidence of intubation response was significantly higher in the groups of fentanyl 2 μg/kg than in the orther 3 groups.The incidences of bradycardia and cough,hiccup were significantly higher in the groups of fentanyl 6,8 μg/kg than in 2,4 μg/kg.Conclusion Four doses of fentanyl could enhance the sedation of propofol and reduce the time of anesthesia induction,the synergism of fentanyl 4 μg/kg is more significant and hemodynamics is more stable.
出处
《新疆医科大学学报》
CAS
2010年第3期310-313,共4页
Journal of Xinjiang Medical University
关键词
芬太尼
二异丙酚
靶控输注
血流动力学
fentanyl
propofol
target-controled infusion
hemodynamics
