复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的半数有效血浆靶浓度

摘要

Objective To determine the median effective plasma concentration (Cp50) of remifentanil inhibiting cardiovascular response to CO2 pneumoperitoneum stimulus when combined with propofol in patients undergoing laparoscopic gynaecological surgery.Methods Twenty-two female patients scheduled for elective laparoscopic gynaecological surgery under general anesthesia, aged20-60 years, with a BMI 18-30 kg/m2, falling into ASA physical statusⅠ orⅡ, were enrolled in this study.Anesthesia was induced with propofol and remifentanil target-controlled infusion and iv injection of rocuronium 0.6 mg/kg.The target plasma concentration (Cp) of remifentanil and propofol were set at 5 ng/ml and 4μg/ml respectively.3 minutes after endotracheal intubation, the Cp of remifentanil was adjusted.The target Cp was set at 6 ng/ml in the first patient.CO2 pneumoperitoneum was performed after the target effect-site concentration and Cp were balanced.Each time Cp increased/decreased by 20％in the next patient depending on whether or not the cardiovascular response to CO2 pneumoperitoneum occurred.The positive cardiovascular response was defined as HR and/or MAP increasing by 20％ within 3 minutes after CO2 pneumoperitoneum.The Cp50 and 95％ confidence interval (CI) of remifentanil required to inhibit cardiovascular response to CO2 pneumoperitoneum stimulus when combined with propofol in patients undergoing laparoscopic gynaecological surgery were calculated.Results The Cp50 (95％ CI) of remifentanil required to inhibit cardiovascular response to CO2 pneumoperitoneum stimulus was 4.58 (4.14-5.08) ng/ml when combined with propofol in patients undergoing laparoscopic gynaecological surgery.Conclusion The Cp50 of remifentanil required to inhibit cardiovascular response to CO2 pneumoperitoneum stimulus was 4.58 ng/ml when combined with propofol in patients undergoing laparoscopic gynaecological surgery.%目的 确定复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的半数有效血浆靶浓度 (median effective plasma concentration, Cp50) .方法 择期拟行妇科腹腔镜手术患者22例, 年龄20～60岁, BMI 18～30kg/m2, ASAⅠ或Ⅱ级.麻醉诱导采用靶控输注 (TCI) 瑞芬太尼和丙泊酚, 对应血浆靶浓度 (Cp) 分别为5ng/ml和4μg/ml, 静脉注射罗库溴铵0.6mg/kg.气管插管后稳定3min, 调整瑞芬太尼Cp, 第1例患者为6ng/ml, 待效应室靶浓度与Cp平衡后建立气腹.发生气腹反应时, 下一例采用高一级浓度, 否则采用低一级浓度, 浓度梯度的比值为1.2.发生气腹反应的标准:建立气腹后3min内HR增快和/或MAP升高幅度超过基础值的20％.计算复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的Cp50及其95％CI.结果 复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的Cp50及其95％CI为4.58 (4.14～5.08) ng/ml.结论 复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的Cp50为4.58ng/ml.