自主呼吸状态下不同浓度瑞芬太尼复合异丙酚麻醉的可行性及安全性研究

摘要

目的 探讨不同浓度瑞芬太尼复合异丙酚靶控输注用于保留自主呼吸手术的可行性及安全性.方法 择期全麻手术患者45例,按瑞芬太尼血浆靶控浓度的不同随机分为3组,每组15例,瑞芬太尼1.5 ng/ml(R1.5),瑞芬太尼1.0 ng/ml (R1.0),瑞芬太尼0.5 ng/ml (R0.5);异丙酚血浆靶控浓度均为2.0 μg/rnl,患者入室后紧闭面罩,氧流量3 L/min,以血浆靶控目标为准,当目标浓度与效应室浓度相等后,记录呼吸功能指标、脑电双频指数(BIS)的变化、OAA/S评分及患者用药前后血气分析的变化.分别于给药前基础值(T0)、达到效应室浓度即刻(T1)、2 min(T2)、6 min (T3)、10 min(T4)时对Mv、VT、RR、PETCO2、SpO2、BIS、OAA/S评分及用药前后pH值、PaCO2、PaO2、Vo/VT等进行比较.结果 与T0比较,3组Mv、VT于T1～4时下降(P＜0.05,P＜0.01),RI.5组RR明显下降(P＜0.01),R0.5组RR各时点变化不显著(P＞0.05).T1～4时R1.5组Mv、VT、RR明显低于R1.0、R0.5组(P＜0.05),PETCO2明显高于R1.0、R0.5组(P＜0.05).3组患者BIS、OAA/S评分T1～4较T0下降(P＜0.01),且R1.5组较R1.0、R0.5组下降明显(P＜0.05,P＜0.01).3组PaCO2、VD/VT用药后较用药前均显著增高(P＜0.01),VD/VT仍在正常范围内,pH值较用药前下降.用药后pH值、PaCO2、、VD/VT在R1.5组明显较R1.0、R0.5组变化大,R0.5组影响最小,3组间差异有统计学意义(P＜0.05).结论 1.0 ng/ml血浆浓度瑞芬太尼复合2.0μg/rnl血浆浓度异丙酚靶控输注用于保留自主呼吸手术较安全,但仍应加强呼吸管理.%Objective To investigate the feasibility and safety of target controlled infusion of remifentanil in combination with propofol for spontaneously breathing patients. Methods Forty-five ASA Ⅰ or Ⅱ patients aged 38 ~ 56 years under general anesthesia were enrolled in the study. The patients were randomly allocated to three groups with 15 patients in each group;propofol + remifentanil (Cp = 1. 5ng/ml) (R1.5), propofol + remifentanil ( Cp = 1. 0ng/ml) (R1.0), propofol + remifentanil ( Cp =0. 5ng/ml) ( R0. 5) the Cp of propofol was at 2. 0μg/ml. When propofol and remifentanil reached target-site concentration, the BIS values, respiratory function variables and OAA/S score were measured before (T0) drug administration, reach the taget-site (T1) and 2-minute ( T2) , 6-minute(T3) , 10-minute (T4 ) thereafter. Mv , VT, RR, PETCO2, SPO2, BIS, OAA/S, PaCO2, PaO2, VD/VT were measured and analyzed. Results Mv, VT at T1~4 were decreased than T0. RR at T1~4 was significantly decreased than T0 in group R1. 5. About RR at T1~4 were no significantly different in group R0. 5. Mv , VT at T1 in group Rl. 5 were lower than in group Rl. 0 and RO. 5 , PETCO2 at T4 in group R1. 5 were higher than in group Rl. 0 and RO. 5( P <0. 05). PaCO2 , VD/VT at T4 were significantly higher than T0 in three groups( P <0. 01 ). pH scale was significantly lower than base values in three groups. There were greater changes in group Rl. 5 than in group Rl. 0 and R0.5. In three groups, BIS, OAA/S score at T1~4 were significantly decreased than T0 ( P < 0.01). BIS, OAA/S score were lower in group Rl. 5 than in group Rl. 0 and R0.5( P <0.05, P <0.01). Conclusion It is safe that 1. 0ng/ml remifentanil and 2. 0μg/ml propofol are combined for spontaneously breathing patients.