| 摘要: |
| ［摘要］ 目的 探讨丙泊酚闭环靶控输注复合依托咪酯和不同剂量瑞芬太尼诱导对高血压患者插管反应的影响。方法 选择广西医科大学附属民族医院2019年1月至2020年3月需接受全麻气管插管腔镜手术的高血压患者90例，采用随机数字表法将其分为瑞芬太尼4 ng/ml组(R1组)、瑞芬太尼5 ng/ml组(R2组)和瑞芬太尼6 ng/ml组(R3组)，每组30例。连接双通道麻醉深度闭环控制注射系统，瑞芬太尼效应室浓度达2 ng/ml后，快速静注依托咪酯0.15 mg/kg并启动丙泊酚1.5 μg/ml血浆靶控闭环回路。三组均待麻醉深度指数（CSI）达60以下后推注维库溴铵0.1 mg/kg。在气管插管前2 min，分别设定瑞芬太尼靶浓度：R1组4 ng/ml、R2组5 ng/ml、R3组6 ng/ml。三组均于维库溴铵推注3 min后行气管插管，插管完成后将瑞芬太尼靶浓度调至2 ng/ml。比较三组入室时(T0)、意识消失时(T1)、气管插管时(T2)、气管插管后1 min(T3)、气管插管后5 min(T4)的平均动脉压(MAP)、心率(HR)。比较三组意识消失时间及T1、T2时间点丙泊酚效应室浓度及用量。记录三组不良反应发生情况和血管活性药物应用等情况。结果 三组意识消失时间以及T1、T2时间点丙泊酚效应室浓度和用量比较差异无统计学意义(P>0.05)。在同一观察时间点内，三组MAP随瑞芬太尼剂量的增大呈下降趋势，三组变化趋势比较差异无统计学意义（P>0.05）。三组HR比较差异无统计学意义（P>0.05）。R1组插管反应发生率显著高于R2组和R3组（P<0.05）；R3组血压降低发生率显著高于R1组（P<0.05）。三组血压增高、硝酸甘油应用、去氧肾上腺素应用情况比较差异无统计学意义（P>0.05）。结论 丙泊酚闭环靶控输注复合依托咪酯和三组剂量的瑞芬太尼诱导镇静效果均理想，5 ng/ml瑞芬太尼更适合用于高血压患者气管插管，镇静效果好，血流动力学平稳，插管反应少。 |
| 关键词: 瑞芬太尼 闭环靶控 高血压 复合麻醉 插管反应 |
| DOI：10.3969/j.issn.1674-3806.2021.12.10 |
| 分类号:R 614.2 |
| 基金项目:广西卫生健康委科研项目（编号：Z20170293） |
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| Effects of closed-loop target-controlled infusion of propofol combined with etomidate and different doses of remifentanil induction on intubation response in hypertensive patients |
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FENG Yan-chun, HUANG Ge, RUAN Hao-shen, et al.
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Department of Anesthesiology, Affiliated Minzu Hospital of Guangxi Medical University, Nanning 530001, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effects of closed-loop target-controlled infusion of propofol combined with etomidate and different doses of remifentanil induction on intubation response in hypertensive patients. Methods Ninety hypertensive patients receiving endoscopic surgery for endotracheal intubation under general anesthesia in Affiliated Minzu Hospital of Guangxi Medical University from January 2019 to March 2020 were selected, and they were divided into 4 ng/ml remifentanil group(R1 group), 5 ng/ml remifentanil group(R2 group) and 6 ng/ml remifentanil group(R3 group) by random number table method, with 30 cases in each group. The double-channel anesthesia depth closed-loop controlled injection system was connected. After the effect-chamber concentration of remifentanil reached 2 ng/ml, etomidate(0.15 mg/kg) was rapidly injected intravenously and then the plasma target-controlled closed-loop of propofol(1.5 μg/ml) was started. Vecuronium(0.1 mg/kg) was injected intravenously in the three groups after the cerebral state index(CSI) was below 60. The target concentrations of remifentanil were set as 4 ng/ml in the R1 group, 5 ng/ml in the R2 group and 6 ng/ml in the R3 group, respectively, two minutes before tracheal intubation. Tracheal intubation was performed three minutes after the vecuronium bolus injection in all the three groups, and the target concentrations of remifentanil were adjusted to 2 ng/ml after intubation. The mean arterial pressure(MAP) and heart rate(HR) were compared among the three groups at the time of entering into the operating room(T0), the time of loss of consciousness(T1), the time of tracheal intubation(T2), 1 minute after tracheal intubation(T3) and 5 minutes after tracheal intubation(T4). The time of loss of consciousness and the effect-site concentration and dosage of propofol at T1 and T2 time points were compared among the three groups. The occurrence of adverse reactions and the application of vasoactive drugs in the three groups were recorded. Results There were no statistically significant differences in the time of loss of consciousness and the effect-site concentration and dosage of propofol at T1 and T2 time points among the three groups(P>0.05). Within the same observation time point, MAP in the three groups showed a downward trend with the increase of remifentanil dose, but there was no significant difference in the trend of changes among the three groups(P>0.05). There was no significant difference in HR among the three groups(P>0.05). The incidence of intubation reaction in the R1 group was significantly higher than that in the R2 and R3 groups(P<0.05). The incidence of blood pressure reduction in the R3 group was significantly higher than that in the R1 group(P<0.05). There were no significant differences in the increase of blood pressure, the application of nitroglycerin, and the application of phenylephrine among the three groups(P>0.05). Conclusion The induced sedative effects of closed-loop target-controlled infusion of propofol combined with etomidate and three groups of remifentanil are satisfactory. Remifentanil at the dose of 5 ng/ml is more suitable for tracheal intubation in hypertensive patients, and it has good sedative effect, stable hemodynamics and less intubation response. |
| Key words: Remifentanil Closed-loop target-controlled infusion Hypertension Compound anesthesia Intubation response |
