摘要
目的 比较芬太尼和利多卡因对异丙酚催眠作用的影响。方法 16 0例择期手术病人分为三组 ,分别采用靶控输注异丙酚 (P组 ,n =30 )、异丙酚 芬太尼 (PF组 ,n =5 2 )或异丙酚 利多卡因(PL组 ,n =78)全静脉麻醉。芬太尼和利多卡因目标血药浓度分别为 2 μg/L、4mg/L。术中行无创血液动力学监测和脑电监测 ,记录麻醉剂用量及麻醉恢复情况。应用高效液相色谱测定异丙酚、利多卡因血药浓度 ,放免法测定芬太尼血药浓度。结果 与P组相比 ,PF组、PL组麻醉诱导意识消失时异丙酚用量ED90 、ED50 无显著性差异 ,意识消失时异丙酚血药浓度Cp90 和Cp50 均明显降低 ,异丙酚麻醉维持用量分别降低 2 9 9%、2 3 9% (P <0 0 5 )。PF组气管插管、切皮前后收缩压 (SP)、舒张压 (DP)无明显改变 ,P组、PL组升高 ,以P组明显 (P <0 0 5 )。三组异丙酚、芬太尼和利多卡因预测误差 (PE)、预测误差绝对值的中位数 (MDAPE)和预测误差的中位数 (MDPE)无明显差异。结论 芬太尼、利多卡因对异丙酚催眠剂量 -反应曲线表现为相加作用 ,浓度 -反应曲线表现为协同作用 ,此差异可能与药代动力学影响有关。芬太尼、利多卡因能减少异丙酚用量 ,抑制气管插管、切皮的血液动力学反应 ,以芬太尼作用明显。
Objective To evaluate the effects of fentanyl and lidocaine on hypnotic effect of propofol in total intravenous anesthesia(TIVA) Methods One hundred and sixty ASAI Ⅲ patients(86 male,74 female) aged (55 0±12 4)yr,weighing (58 0±9 8)kg,scheduled for elective surgery were randomly divided into propofol group(group P,n=30), propofol fentanyl group(group PF,n=52) and propofol lidocaine group (group PL,n=78) Patients with kidney and liver dysfunction, hypertension, neurological and mental disease were excluded All patients were premedicated with intramuscular phenobarbital 0 1g and atropine 0 5mg BP,HR,SpO 2 and BIS were continuously monitored The patients were anesthetized by TIVA with TCI The target plasma concentration for fentanyl was 2μg/L(group PF) and for lidocaine 4mg/L(group PL) The initial target plasma concentration of propofol was set at 1mg/L When pre set concentration was reached, target propofol plasma concentration was increased by increments of 0 5mg/L until loss of consciousness Blood samples were taken before anesthesia(T 0), loss of consciousness(T 1), immediately after intubation(T 2), at skin incision(T 3), 5 and 10 min after skin incision(T 4,T 5), when TIVA was ended (T 6) and when the patient waked up(T 7) for determination of plasma concentrations of propofol, fentanyl and lidocaine Results ED 90 and ED 50 of propofol for loss of consciousness were lower in group PF and PL than those in group P but the difference was of no statistical significance (P<0 05) Cp 50 and Cp 90 of propofol required for loss of consciousness in group PF and group PL were significantly lower than those in group P(P<0 05) The dose of propofol required for maintenance of anesthesia were reduced by 29 9% in group PF and 23 9% in group PL Systolic and diastolic blood pressure increased significantly after intubation and at skin incision in group P and group PL There was little difference in PE, MDAPE and MDPE of proplfol, fentanyl and
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2001年第10期617-620,共4页
Chinese Journal of Anesthesiology
