摘要
目的探讨瑞芬太尼抑制置入喉罩时应激反应的性别差异。方法适合术中通过喉罩维持机械通气的择期全麻手术患者77例, 40例男性患者和37例女性患者各随机分为2组:MP组(男性丙泊酚组, n=20)、 FP组(女性丙泊酚组, n=19)、 MR组(男性丙泊酚联合瑞芬太尼组, n=20)、 FR组(女性丙泊酚联合瑞芬太尼组, n=18)。采用血浆靶控输注模式对患者进行全麻诱导,其中MP组、 FP组丙泊酚初始浓度设为5.0μg·m L-1;MR组、 FR组丙泊酚初始浓度设为3.0μg·m L-1同时靶控输注瑞芬太尼2.0 ng·m L-1。待丙泊酚血药浓度达到平衡时插入喉罩,通过序贯法对置入喉罩时丙泊酚浓度进行观察记录,下一例患者上下增减幅度为0.5μg·m L-1。观察并记录麻醉诱导前(T0),置入喉罩前1 min (T1),置入喉罩时(T2),置入喉罩后l min (T3)、 2 min (T4)患者的平均动脉压(MAP)、心率(HR)和脑电双频指数(BIS)值。结果诱导后, 4组患者MAP、 BIS值都较诱导前显著下降(P <0.05)。MP组T1、 T3、T4时HR较T0时显著下降(P <0.05), FP组T4时HR显著下降(P <0.05), MR组、 FR组T0~T4时HR均无明显变化(P> 0.05)。MP组T1、 T3、 T4时MAP显著低于MR组(P <0.05), FP组T1时MAP显著低于FR组(P <0.05), 4组间各观察时点HR比较无显著差异(P> 0.05)。T1~T4时MP组、 FP组的BIS值显著低于MR组、 FR组(P <0.05)。MP组、 FP组、 MR组、 FR组丙泊酚半数有效浓度分别为(5.00±0.49)、(5.07±0.42)、(2.60±0.42)、(2.19±0.46)μg·m L-1,其中MR组、 FR组显著低于MP组、 FP组(P <0.05), MP组与FP组比较无显著差异(P> 0.05), FR组显著低于MR组(P <0.05)。4组患者均未出现明显不良反应。结论女性患者对瑞芬太尼抑制插入喉罩应激反应作用的敏感性更强。诱导期,丙泊酚联合瑞芬太尼靶控输注诱导较单独丙泊酚靶控输注诱导更能达到血流动力学的稳定。
AIM To evaluate the sex differences in remifentanil reducing the stress responses for the insertion of a laryngeal mask airway.METHODS Seventy-seven patients scheduled for elective general anesthesia surgery with mechanical ventilation through a laryngeal mask during were included.Forty male patients were randomly divided into 2 groups which was the same as female patients:MP group(n=20)/FP group(n=19):propofol target-controlled infusion(TCI)separately;MR group(n=20)/FR group(n=18):propofol TCI with remifentanil.The patient was subjected to general anesthesia induction by plasma controlled infusion mode.The initial concentration of propofol in the MP group/FP group was set to 5.0μg·m L-1;the initial concentration of propofol in the MR group/FR group was set to 3.0μg·m L-1 and remifentanil TCI at a plasma concentration of2.0 ng·m L-1.The laryngeal m ask was inserted when the plasma concentration of propofol reached equilibrium.Median effective concentration(cp50)of propofol were calculated with the staircase method which increasing or decreasing 0.5μg·m L-1 according to body movement of patients.The mean arterial pressure(MAP),heart rate(HR),and bispectral index(BIS)were recorded before anesthesia induction(T0),1 minute before laryngeal mask insertion(T1),at inserting the laryngeal mask(T2),l and 2 minutes after laryngeal mask inserted(T3 and T4).RESULTS The MAP and BIS values after induction in the four groups were significantly lower than those before induction(P<0.05).Compared with that at T0,the HR of the MP group at T1,T3,T4 was significantly lower(P<0.05),and the HR of the FP group at T4 was significantly lower(P<0.05).There was no significant difference of HR in the MR group and FR group at each time period(P>0.05).The MAP of the MP group was significantly lower than that of the MR group at T1,T3,T4(P<0.05).The MAP of the FP group was significantly lower than that of the FR group at T1(P<0.05).There were no significant differences in HR among the four groups(P>0.05).The BIS of the MP group and FP gro
作者
孙若冰
吕黄伟
SUN Ruo-bing;L譈Huang-wei(Department of Anesthesiology,the First Hospital of China Medical University,Shenyang LIAONING 110001,China;Department of Anesthesiology,the First Central Hospital of Tianjin,TIANJIN 300192,China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2019年第9期546-550,共5页
Chinese Journal of New Drugs and Clinical Remedies
关键词
性别因素
瑞芬太尼
丙泊酚
喉罩
应激反应
sex factors
remifentanil
propofol
laryngeal mask
stress responses
