目的:探讨瑞芬太尼在局麻下腹主动脉瘤介入手术中清醒镇静的有效靶控输注浓度.方法:将60例ASA II～III级局麻下EAAA手术患者按瑞芬太尼靶控输注目标浓度的设定随机分为4组[R1组(1.0 ng/ml)、R2组(2.0 ng/ml)、R3组(3.0 ng/ml)R4组(3.5 ng/ml)].术中镇静指标包括:每5分钟用警觉/镇静(OAA/S)评分1次,脑电双频谱指数(BIS)持续记录;术中持续观察患者焦虑状态和瑞芬太尼的的输注情况;疼痛评分采用视觉模拟评分(VAS)法;其他指标包括术中呼吸循环指标、术后患者并发症以及出院时间等.结果:OAA/S评分显示:R3组评分为3.96分,R4组评分为3.31分,两组评分显著低于R1组(4.31分)和R2组(4.26分);R4组术中呼吸抑制的发生率显著高于其他三组(P＜0.05);VAS评分显示:R1 组评分为1.49±0.62分,显著高于其他三组(P＜0.05,R2 组为0.85±0.60分,R3 组为0.35±0.40分,R4组为0.31±0.50分);各组在围术期BIS水平、焦虑评估、呼吸循环系统的稳定性,以及出院转归时间等方面无显著性差异(P＞0.05).结论:在局麻下的腹主动脉瘤介入手术中,将瑞芬太尼目标浓度设定在3.0 ng/ml行靶控输注时,可有效达到清醒镇静和完善镇痛的同时,并可提高术中心血管系统的稳定性.%Objective: To define the optimal target concentration of Remifentanil which effectively a-chieves conscious sedation and analgesic stability during abdominal aortic aneurysm endovascular repair with local an -esthesia .Methods : Sixty patients underwent local anesthesia with lidocaine 1% (maximum safe dose 4 mg/kg) and were infused with a target controlled infusion (TCI) of Remifentanil at 1 .0 ng/ml (group Rl, n = 15), 2 .0 ng/ml (group R2 , n = 15) , 3 .0 ng/ml (group R3 , n = 15) , and 3 .5 ng/ml (group R4, n = 15 ). Observer's assessment of alertness /sedation (OAA/S) scale, the bispectral index (BIS) , anxiety levels and infusion rate of Remifentanil were monitored during the operation . Pain control was measured by visual analogue scale . Outcome included cardiorespiratory stability . Time-relate outcomes included operating time , length of stay in intensive care unit and hospital. Results : OAA/S scale was significantly lower in groups R3 (3 .96) and R4 (3 .31) than groups Rl (4 .31) and R2 (4.26). Incidence of intraoperative respiratory depression events was significantly higher in group R4 than the other groups . Mean Visual Analogue Scale were significantly lower in groups R2 (0 .85±0 .60) and R3 (0 .35± 0 .40) and R4(0 .31 ± 0 .50) than groups Rl (1.49 ± 0 .62). There were no significant differences in BIS , anxiety level and incidences of recall of the operative procedure among the groups .There were no relevant differences concerning cardiorespiratory stability and other outcomes .Conclusion: We conclude that the TCI of remifentanil at 3 .0 ng/ml with local anesthesia produces an effective sedation and stable pain control , which is shown to be safe and most importantly effective in offering cardiovascular stability during abdominal aortic aneurysm endovascular repair.
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