目的 评价不同剂量舒芬太尼复合靶控输注异丙酚麻醉诱导对患者血液动力学的影响,探讨复合异丙酚时舒芬太尼的适宜麻醉诱导剂量.方法 本试验为前瞻性、多中心、随机、双盲的临床研究.拟行腹部手术患者165例,ASA Ⅰ或Ⅱ级,年龄18～63岁,性别不限,体重42～90 kg,根据舒芬太尼不同麻醉诱导剂量分为4组:舒芬太尼0.4 μg/kg组(S1组,n=44)、0.6 μg/kg组(S2组,n=43)、0.8 μg/kg组(S3组,n=38)、1 μg/kg组(S4组,n=40).麻醉诱导:静脉注射咪达唑仑0.05 mg/kg,靶控输注异丙酚,血浆靶浓度3.0 μg/ml,当BIS<60且异丙酚达设定血浆靶浓度时,各组经30 s分别静脉注射舒芬太尼0.4、0.6、0.8、1 μg/kg,四组均静脉注射罗库溴铵0.9 mg/kg,静脉注射舒芬太尼后3 min(BIS 35～45)行气管插管、机械通气.于麻醉诱导前(T0)、异丙酚血浆靶浓度3.0 μg/ml时(T1)、静脉注射舒芬太尼后1 min(T2)、3 min(T3)、气管插管后即刻(T4)、1 min(T5)、3 min(T6)、5 min(T7)时记录SP、DP、MAP和HR.记录心血管不良事件和气管插管反应的发生情况.结果 四组麻醉诱导期间低血压、高血压和心动过速的发生率比较差异无统计学意义(P>0.05),T4-7时S4组心动过缓发生率较其余各组升高(P<0.05);S1组和S2组气管插管反应发生率较S3组和S4组升高(P<0.05或0.01).结论 舒芬太尼0.8 μg/kg复合靶控输注异丙酚(血浆靶浓度3.0 μg/ml)麻醉诱导时患者血液动力学平稳,是复合异丙酚时舒芬太尼适宜的麻醉诱导剂量.%Objective To investigate the effects of different doses of sufentanil combined with target controlled infusion (TCI) of propofol on hemodynamics in patients during anesthesia induction and the appropriate dose of sufentanil. Methods This was a prospective, multicenter, randomized, double-blind clinical trial. One hundred and sixty-five patients of both sexes, ASA Ⅰ or Ⅱ , aged 18-63 yr, weighing 42-90 kg, scheduled for elective abdominal surgery, were divided into 4 groups according to the different induction doses of sufentanil: snfentanil 0.4 μg/kg group (group S1, n=44), 0.6 μg/kg group (group S2, n=43), 0.8 μg/kg group (group S3, n=38) and 1 μg/kg group (group S4, n=40). Anesthesia was induced with iv injection of midazolam 0.05 mg/kg, TCI of propofol (target plasma concentration set at 3.0 μg/ml) and iv injection of sufentanil 0.4, 0.6, 0.8 and 1 μg/kg. Tracheal intubation was facilitated with rocuronium 0.9 mg/kg. The patients were mechanically ventilated (BIS at 35-45). Systolic pressure (SP), diastolic pressure (DP), MAP and HR were recorded before induction of anaesthesia (T0), at the time of propofol achieving the target plasma concentration of 3.0 μg/ml (T1), at 1 min (T2) and 3 min(T3) after injection of sufentanil, and immediately (T4) and at 1 min (T5), 3 min (T6) and 5 min (T7) after tracheal intubation. The adverse cardiovascular events including bradycardia, tachycardia, hypertension and hypotension, and hemodynamic responses to intubation were also recorded. Results There were no significant differences in the incidence of hypotension, hypertension and tachycardia during anesthesia induction between 4 groups. The incidence of bradycardia at T4-7 was significantly higher in group S4 than in the other 3 groups. The incidence of intubation response was significantly higher in group S1 and S2 than in group S3 and S4. Conclusion Sufentanil 0.8 μg/kg is the dose of choice for anesthesia induction when combined with propofol TCI (target plasma concentration set at 3.0 μg/ml) in patients and hemodynamics is stable.
展开▼
