摘要
目的 针对老年患者,在全麻诱导期联合不同血浆靶浓度的瑞芬太尼,设计不同的丙泊酚起始血浆靶浓度分步靶控诱导,选出最佳给药方案。方法 选取安徽医科大学附属省立医院2017-04/2018-11期间择期全麻手术的老年患者80例,年龄65~79岁, ASA分级Ⅰ~Ⅲ级,随机分为4组。 A组:丙泊酚起始血浆靶浓度1.5 μg/mL,瑞芬太尼血浆靶浓度2.0 ng/mL;B组:丙泊酚起始血浆靶浓度2.0 μg/mL,瑞芬太尼血浆靶浓度2.0 ng/mL;C组:丙泊酚起始血浆靶浓度1.5 μg/mL,瑞芬太尼血浆靶浓度3.0 ng/mL;D组:丙泊酚起始血浆靶浓度2.0 μg/mL,瑞芬太尼血浆靶浓度3.0 ng/mL。每组每60 s递增丙泊酚血浆靶浓度1.0 μg/mL,直到患者意识消失(LOC)。监测LOC的时间;LOC时以及插管前丙泊酚血浆浓度、效应室浓度;诱导前(T0)、 LOC时(T1)、插管前(T2)、插管后即刻(T3)、 1 min(T4)、 3 min(T5)、 5 min(T6)的平均动脉压(MAP)、心率(HR);T0-T4时点的脑电双频谱指数(BIS)值。结果 与T0相比, A、 B、 D 3组插管后T3、 T4时点MAP、 HR明显升高(P<0.05), C组MAP明显降低(P<0.05)、 HR无统计学意义(P>0.05);与T2相比, A、 B、 C 3组插管后BIS值差异无统计学意义(P>0.05), D组有统计学意义(P<0.05)。 D组意识消失最快(1.7±0.45) min;LOC时、插管前丙泊酚效应室浓度A与C组明显高于B与D组。结论 在老年患者对比4种诱导方法中,丙泊酚起始血浆靶浓度为1.5 μg/mL,瑞芬太尼血浆靶浓度为3.0 ng/mL时,诱导期血流动力学最平稳。
Objective To screen out the best drug delivery scheme of propofol step-by-step target controlled infusion combined with remifentanil of different plasma concentrations, suitable for elderly patients during induction of general anesthesia. Methods Eighty American Society of Anesthesiologists physical status Ⅰ-Ⅲ elderly patients, aged 65-79 years, scheduled for elective surgeries under general anesthesia in the Affiliated Provincial Hospital of Anhui Medical University from April 2017 to November 2018 were randomly divided into 4 groups (n=20 each): group A (the initial target plasma concentration of propofol was 1.5 μg/mL, the target plasma concentration of remifentanil was 2.0 ng/mL), group B (the initial target plasma concentration of propofol was 2.0 μg/mL, the target plasma concentration of remifentanil was 2.0 ng/mL), group C (the initial target plasma concentration of propofol was 1.5 μg/mL, the target plasma concentration of remifentanil was 3.0 ng/mL) and group D (the initial target plasma concentration of propofol was 2.0 μg/mL, the target plasma concentration of remifentanil was 3.0 ng/mL). The propofol plasma target concentration was then increased by 1.0 μg/mL every 60 s until the patients lost their consciousness. The time of loss of consciousness was recorded;mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (T0), LOC (T1), before tracheal intubation (T2) and after intubation (T3), 1 min (T4), 3 min (T5), and 5 min (T6) afterwards. The propofol plasma concentrations and effect-site concentrations were recorded at T1-T2;BIS was recorded at T0-T4. Results Compared with T0, MAP and HR in group A, B and D increased significantly at T3 and T4 after intubation (P<0.05), while MAP in group C decreased significantly (P<0.05) with no significant difference in HR (P>0.05). Compared with T2, there was no significant difference in BIS values after intubation in group A, B and C (P>0.05), but there was a difference in group D (P<0.05). The time of loss of consciousness in gr
作者
陈香香
郭凤林
陆心仪
张凯
魏昕
CHEN Xiangxiang;GUO Fenglin;LU Xinyi;ZHANG Kai;WEI Xin(Department of Anesthesiology,The affiliated Provincial Hospital of Anhui Medical University,Hefei 230001,China)
出处
《麻醉安全与质控》
2019年第3期145-149,共5页
Perioperative Safety and Quality Assurance
基金
国家自然科学青年基金(81300970)
关键词
丙泊酚
靶控输注
老年患者
propofol
target controlled infusion
elderly patients
