不同浓度靶控输注瑞芬太尼对切皮前后BIS值的影响

Impact of remifantanil TCI concentration on BIS values obtained in the periods of pre-incision and post-incision

关键词:  丙泊酚  瑞芬太尼  TCI  BIS

Key words:  propofol  remifentanil  TCI  BIS

摘要:

目的　比较在恒定的丙泊酚静脉靶控输注行全身麻醉维持期间，应用不同浓度靶控输注瑞芬太尼，观察病人切皮前后脑电双频指数(bispectral index,BIS）值变化，探讨疼痛剌激对BIS值的影响程度。〖ＨＴH〗方法　择期行开腹手术患者100例，随机分为5组，每组20例。入室开放静脉通路，记录患者诱导前血压（Bp）、心率（HR）、BIS值。应用TCI(静脉靶控输注)输注丙泊酚，维持患者血浆靶浓度3.5 μg/mL，静脉注射顺式阿曲库铵0.2 mg/kg行麻醉诱导。置入喉罩，确定喉罩位置适合后，建立机械通气，潮气量8 mL/kg、呼吸频率12次/min、吸呼比1∶〖KG-*2〗2 。在维持丙泊酚效应室浓度不变，5组病人分别以2.0 ng/mL、4.0 ng/mL、6.0 ng/mL、8.0 ng/mL和10.0 ng/mL靶控浓度输注瑞芬太尼。记录手术开始切皮前以及切皮后1 min患者的Bp、HR、BIS值的变化。〖ＨＴH〗结果　瑞芬太尼血药浓度为2.0 ng/mL、4.0 ng/mL、6.0 ng/mL的患者，切皮后的BIS值较切皮前明显升高，其变化值分别为24.0±5.7、22.4±5.9、17.6±3.7，与切皮前比较差异具有显著性意义(P<0.05); 血药浓度为8.0 ng/mL、10.0 ng/mL组，切皮前后BIS值的变化较小，分别为4.1±5.5、4.0±4.2，差异无显著性意义。〖ＨＴH〗结论　以靶控输注丙泊酚和瑞芬太尼行麻醉维持，当丙泊酚血浆靶浓度为3.5 μg/mL时，采用不同浓度的瑞芬太尼靶控输注，切皮前后病人的BIS值的变化存在明显差异。然而，这两种药物组合实施TCI麻醉期间，能够维持切皮前后BIS值介于40～60之间的各自最佳TCI用药方案仍有等于进一步观察与研究。

Abstract:

Objective　To identify the impact of remifentanil TCI concentration on the BIS values in the periods of the pre-incision and post-incision. 　Methods　One hundred female patients underwent open gynecologic surgeries were included in the study. The patients were randomly divided into 5 groups (20 cases each group), according to the delivered TCI concentration of remifentanil. The Propofol was infused constantly at the TCI concentration of 3.5 μg/mL following induction of anesthesia. The airway was secured with laryngeal mask and lungs were ventilated mechanically. The remifentanil was infused constantly at the levels of 2.0, 4.0, 6.0 ,8.0 and 10.0 ng/mL according to predefined regimens in the five groups. The baseline values of HR, MAP and BIS were recorded and the values of variables obtained at the pre-insicion and post-insicion periods were compared using ANOVA. P value <0.05 was considered as statistical significance.　Results　The BIS values were significantly increased after incision in the groups of 2.0, 4.0, 6.0 ng/mL TCI concentration of remifentanil compared with the BIS values obtained at pre-insicion period. The changes of HR and MAP were shown to be similar as the changes of BIS values. 　Conclusion　The TCI concentration of remifentanil played an important rule in the changes of BIS values in the pre- and post-insicion periods when TCI concentration of propofol was kept constantly at 3.5μg/mL level. However, the optimal TCI concentration of propofol and remifentanil to keep the BIS values between 40-60 remains to be further investigated.