3个年龄段全麻中瑞芬太尼、丙泊酚最佳配伍维持剂量间量效关系比较
Comparison on dose effect relationship of remifentanil and propofol with optimal compatibility maintenance dose among three age groups in general anesthesia
陈丽 1刘华 1康力 1王珊 1袁承城 1吕东森1
作者信息
- 1. 广东省深圳市宝安区中医院,广东 深圳518133
- 折叠
摘要
目的 比较老年、中青年、儿童患者静脉复合全麻维持中的瑞芬太尼、丙泊酚最佳配伍量效关系,找出3个年龄段全麻维持效果相同时瑞芬太尼、丙泊酚配伍用量的差异,为临床麻醉提供参考.方法 回顾已按照科研计划实施的老年、中青年、儿童全麻患者资料,将3个年龄段各自全麻维持效果最佳的一组分别定为老年组(L组,15例)、中青年组(Z组,30例)、小儿组(X组,20例).全麻诱导:L组泵注依托咪酯0.15 mg/kg、瑞芬太尼15 μg/kg,同时静注阿托品0.007 mg/kg、维库溴铵0.12 mg/kg;Z组泵注依托咪酯0.3 mg/kg、瑞芬太尼15 μg/kg,同时静注阿托品0.007 mg/kg、维库溴铵0.12 mg/kg;X组泵注丙泊酚1.5 mg/kg、瑞芬太尼15 μg/kg,同时静注阿托品0.008 mg/kg、维库溴铵0.12 mg/kg.全麻维持:L组恒速泵注瑞芬太尼50 μg/(kg·h),调节丙泊酚用量控制并维持麻醉中MAP(简称维持MAP)比其基础MAP降低5%(0~10%)左右;Z组和X组均是恒速泵注丙泊酚5 mg/(kg·h),调节瑞芬太尼用量控制并维持麻醉中MAP比其基础MAP降低5%左右.3组均在手术结束前5 min停止降压.结果 3组全麻维持效果评级均达到Ⅰ级,3组间维持MAP平稳指数比较差异无统计学意义(P均>0.05);3组维持MAP平稳指数比基础MAP平稳指数均在36.70% ~68.30%;3组间睁眼时间比较差异无统计学意义,均无清醒躁动及术中知晓病例出现.X组实际瑞芬太尼用量明显多于L组和Z组(P均<0.05),L组实际丙泊酚用量明显少于X组和Z组(P均<0.05).结论 3个年龄段达到同样的全麻维持效果Ⅰ级时,儿童患者瑞芬太尼用量多于老年和中青年患者,老年患者丙泊酚用量少于儿童和中青年患者.儿童、中青年患者应采用固定丙泊酚用量调节瑞芬太尼用量控制MAP的麻醉用药方法,老年患者应采用固定瑞芬太尼用量调节丙泊酚用量控制MAP的麻醉用药方法.
Abstract
Objective It is to compare the best dose effect relationship of remifentanil and propofol in the maintenance of intravenous anesthesia for elderly,young and middle-aged and children,find out the difference of the dosage of remifen-tanil and propofol in the maintenance effect of general anesthesia among the 3 age groups,and provide reference for clinical anesthesia. Methods The data of general anesthesia for elderly,middle-aged and young children who have been implemen-ted according to the scientific research plan was reviewed. The group with the best results of the three age groups was deter-mined to be the elderly group (group L,15 cases), young and middle-aged group (group Z,30 cases), children group (group X,20 cases). General anesthesia induction:the patients were injected with etomidate 0.15 mg/kg and remifentanil 15 μg/kg,and intravenous injection of atropine 0.007 mg/kg and vecuronium 0.12 mg/kg in group L;and with etomidate 0.3 mg/kg and remifentanil 15 μg/kg,and intravenous injection of atropine 0.007 mg/kg and vecuronium 0.12 mg/kg in group Z;with propofol 1.5 mg/kg and remifentanil 15 μg/kg,and intravenous injection of atropine 0.008mg/kg and vecu-ronium 0.12 mg/kg in group X. Maintenance of general anesthesia: the patients in the group L were received constant speed infusion of remifentanil 50 μg/(kg·h), adjusting propofol dosage to maintain and maintain MAP in anesthesia (MAP) was 5% lower than basal MAP (0 to 10%);the group Z and group X were propofol 5 mg/(kg·h) at constant speed. The amount of remifentanil adjusted to maintain MAP in anesthesia was 5% lower than that in its basal MAP. All the patients were stopped reducing blood press five minites before the end of the surgery. Results The average maintenance effect of general anesthesia reached grade I. There was no significant difference in maintaining MAP stable index among the three groups (all P>0.05). The stable index of MAP maintained in the three groups was 36.70% to 68.30% above that of the base MAP. There was no significant difference in eye opening time among the three groups(all P>0.05). No wa-king restlessness and intraoperative awareness were found. The actual dosage of remifentanil in group X was significantly higher than that in group L and group Z(all P<0.05). The actual dosage of propofol in group L was significantly less than that in group X and group Z (all P<0.05).Conclusion When the three age groups achieved the same general anesthesia maintenance effect with levelⅠ,the dosage of remifentanil in children was higher than that in young and middle-aged and elderly patients,the dosage of propofol in elderly patients is less than that in young and middle-aged and children patients. Children,young and middle-aged patients should use the fixed propofol dosage to adjust the dosage of remifentanil to control MAP,elderly patients should use the dosage of fixed remifentanil to adjust the dosage of propofol to control MAP.
关键词
老年人/中青年人/儿童/瑞芬太尼用量/丙泊酚用量/量效关系Key words
elderly/young and middle-aged people/children/remifentanil dosage/propofol dosage/dose effect rela-tionship引用本文复制引用
出版年
2018
国家科技期刊平台
NSTL
维普
万方数据