本文選題：意識(shí)指數(shù) + 瑞芬太尼��； 參考：《廣東醫(yī)學(xué)》2017年08期

【摘要】：目的探討意識(shí)指數(shù)2(IOC2)監(jiān)測(cè)與瑞芬太尼在無(wú)痛胃鏡檢查中的相關(guān)性。方法擇期行無(wú)痛胃鏡檢查患者80例,按數(shù)字表法隨機(jī)分為C組和R2、R4、R6組,每組20例。麻醉誘導(dǎo):C組采用靜脈推注丙泊酚1.5~2.5 mg/kg(0.3 mL/s),R2、R4、R6組在輸注丙泊酚同時(shí)分別靶控輸注2、4、6 ng/mL瑞芬太尼(MINTO模型,血漿濃度),到達(dá)目標(biāo)濃度后停止輸注該藥。各組麻醉維持均為持續(xù)輸注丙泊酚4~12 mg/(kg·h),IOC1維持于40~60時(shí)開(kāi)始胃鏡檢查。術(shù)中心率(HR)、平均動(dòng)脈壓(MAP)高于基礎(chǔ)值20%或發(fā)生體動(dòng)反應(yīng)時(shí),單次追加丙泊酚20~40 mg,必要時(shí)給予烏拉地爾10~20 mg,HR、MAP低于基礎(chǔ)值20%時(shí)予加快輸液及減小丙泊酚輸注速率,必要時(shí)給予阿托品0.5 mg或麻黃堿5~15 mg,所有患者脈搏血氧飽和度(SpO_2)低于95%時(shí)行下頜關(guān)節(jié)托舉,SpO_2持續(xù)低于90%超過(guò)2 min時(shí)停止所有操作,行面罩吸氧及手控輔助呼吸。記錄各組患者術(shù)前(T1)、鏡檢開(kāi)始(T2)、鏡檢結(jié)束(T3)及術(shù)畢5 min(T4)的IOC1和IOC2,并記錄IOC2最低值和起效時(shí)間(麻醉誘導(dǎo)開(kāi)始到IOC2下降至最低值)、圍術(shù)期低血壓、高血壓、心動(dòng)過(guò)緩、心動(dòng)過(guò)速、低氧血癥、體動(dòng)反應(yīng)發(fā)生情況、丙泊酚用量及蘇醒時(shí)間。結(jié)果隨著瑞芬太尼劑量增加,R4和R6組丙泊酚用量減少、蘇醒時(shí)間縮短、IOC2最低值變小,起效時(shí)間較短(P0.05),IOC2最低值與瑞芬太尼濃度呈負(fù)相關(guān),其相關(guān)系數(shù)為-0.297。結(jié)論 IOC2與瑞芬太尼呈負(fù)相關(guān),隨著瑞芬太尼劑量增加,起效時(shí)間縮短。
[Abstract]:Objective to investigate the correlation between consciousness index 2 IOC 2 and remifentanil in painless gastroscopy. Methods Eighty patients with painless gastroscopy were randomly divided into group C (n = 20) and group R _ 2 (n = 20). Anesthesia induced group C was treated with propofol 1.5 mg/kg(0.3 / L and 2.5 mg/kg(0.3 / ml / L / L R2P / R _ 4 / R _ 4 / R _ (6) group respectively. The plasma concentration of propofol was reduced after the injection of propofol was controlled at the same time by target-controlled infusion of 2 ng/mL remifentanil and MINTO model. The plasma concentration of propofol was up to the target concentration and the infusion was stopped after the injection of propofol. The maintenance of anesthesia was continuous infusion of propofol for 12 mg/(kg and IOC1 was maintained at 40 ~ 60. During the operation, the heart rate and mean arterial pressure (MAPP) were 20% higher than the basic value or 40 mg of propofol 20 mg, and when Urapidil 1020 mg HRMAP was given lower than the basic value 20%, the infusion rate of propofol was decreased and the infusion rate of propofol was decreased. All patients were given atropine 0.5 mg or ephedrine 5 mg or ephedrine 15 mg if necessary. All patients were treated with SPO _ 2 (pulse oxygen saturation) < 95%. All operations were stopped when the mandibular joint lift SpO-2 remained below 90% or more than 2 min, mask oxygen inhalation and manual assisted respiration were performed. The IOC1 and IOC2 of the patients in each group were recorded before operation (T _ 1, T _ 2, T _ 3, T _ 3) and 5 min after operation, and the minimum value and onset time of IOC2 (from induction of anesthesia to the lowest value of IOC2, perioperative hypotension, hypertension, bradycardia, tachycardia) were recorded. Hypoxemia, body movement, propofol dosage and recovery time. Results with the increase of remifentanil dosage, the dosage of propofol decreased, the minimum value of IOC2 decreased, and the lowest value of IOC2 was negatively correlated with the concentration of remifentanil. The correlation coefficient was -0.297. Conclusion there is a negative correlation between IOC2 and remifentanil, and the onset time is shortened with the increase of remifentanil dosage.
【作者單位】： 深圳市第三人民醫(yī)院麻醉科;
【分類號(hào)】：R614

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