两种效应室靶浓度瑞芬太尼用于全麻诱导的观察

两种效应室靶浓度瑞芬太尼用于全麻诱导的观察 夏星 田鸣 北京友谊医院 100000 中文摘要 目的 比较两种效应室靶浓度瑞芬太尼诱导时的血流动力学及脑电双频指 数（BIS）和听觉诱发电位指数(AAI)的变化。根据所得数值，为临床合理使用 瑞芬太尼提供参考。使对不同情况的病人可以选择不同剂量的瑞芬太尼来达到 安全有效的诱导效果。 方法 30例ASA级择期全麻下行腹腔镜胆囊切除手术病人，年龄 2060岁，ASA级，按瑞芬太尼效应室靶浓度不同，病人随机分为2组(R4 组和R6组) ，每组 15例。R4组和R6组瑞芬太尼诱导剂量分别为4ng/ml，6ng/ml； 诱导时设定异丙酚血浆靶浓度3g/ml,瑞芬太尼效应室靶浓度为4，6ng/ml。先 仅予异丙酚，待病人意识消失后，开始泵入瑞芬太尼，并静注罗库溴铵 0.6mg/kg。待瑞芬太尼达设定的靶浓度且肌松满意后完成气管插管。记录基础 值(T1) ，意识消失时 (T2)，插管前即刻 (T3)及之后3分钟(T4-T6) 的 HR、SBP、DBP、MBP、 BIS和AAI数值。 结果 （1）麻醉诱导及插管时的血流动力学变化：两组诱导时的血流动力学指标 (HR，SBP ， DBP，MAP)均明显低于基础值（P0.05)。 （2）BIS 和 AAI 的变化：两组在麻醉诱导后的 BIS 值均比基础值显著下 降(P0.05)；且两组间同一时间点的 BIS 值也无显著性差异。同样， 各组在麻醉诱导后的 AAI 均比基础值显著下降(P0.05） 。 结论 （1）异丙酚血浆靶浓度 3g/ml 复合瑞芬太尼效应室靶浓度 4ng/ml 至 6ng/ml 诱导均能较好的控制插管时的血液动力学反应，是一种可行的诱导方法。 （2）瑞芬太尼效应室靶浓度为 4ng/ml 时虽可减轻气管插管时的心血管反 应，却并不能使插管刺激得到充分抑制，而瑞芬太尼效应室靶浓度为 6ng/ml 时， 既能有效减轻气管插管时的心血管反应，且能使插管刺激得到充分抑制。 （3）BIS 和 AAI 都可以作为麻醉诱导期麻醉深度监测的可靠指标；BIS 和 AAI 都可以作为麻醉诱导期麻醉深度监测的可靠指标；AAI 与 BIS 相比,在 伤害性刺激未得到充分抑制时，AAI 还可反映机体由于插管刺激产生的应激反 应。 关键词 异丙酚 瑞芬太尼 脑电双频指数 听觉诱发电位指数 麻醉诱 导 The Comparison of Different Effect-site Concentration of TCI Remifentanil Combined with Propofol during General Anesthesia Abstract Objective: To compare the effects of target-controlled infusion (TCI) of remifentanil in various doses in combination of TCI propofol on hemodynamic response to tracheal intubation and the changes of bispectrial index ( BIS ) and A2line ARX Index (AAI ). Methods: 30 patients, ASA I-II, undergoing laparascopic cholecystectomy ,aged 20-60, were randomly divided into 2 groups: Group R4 (n=15) the targeting effect- site concentration of remifentanil was 4ng/ml; Group R6 (n=15) the targeting effect- site concentration of remifentanil was 6ng/ml. The general anesthesia induction was performed by propofol (plasma concentration was 3g/ml) using TCI technique. The remifentanil was started after the loss of consciousness. Tracheal intubation was performed following rocuronium(0.6mg/kg) iv when the remifentanil effect-site concentration was reached. The HR,SBP,DBP,MBP,BIS and AAI values of baseline, time when loss of consciousness, time when intubating and the 3 time point per minute after intubation were recorded. Results : (1) Hemodynamic varieties: HR，SBP，DBP and MAP were significantly decreased in all patients during induction compared with baseline（P0.05）. The AAI values of 1 min, 2min, 3 min after intubation were increased significantly in R4 (P0.05). Conclusion : (1)The target plasma propofol concentrateion of 3 g/ml in the presence of effect- site remifentanil concentration of 4 to 6 ng/ml can attenuate the hemodynamic response to tracheal intubation, so it is safe and effective for induction of anesthesia. (2) Induction with 4ng/ml (the targeting effect-site concentration ) remifentanil can attenuate the hemodynamic response to tracheal intubation but can not restrain the intubation stimulation sufficiently; Induction with 6ng/ml (the targeting effect-site concentration ) remifentanil can attenuate the hemodynamic response to tracheal intubation and can restrain the intubation stimulation sufficiently. (3) Both BIS and AAI can be reliable maker for monitoring the depth of anesthesia during anesthesia induction; and AAI can reflect the reaction of intubation when the noxious