本文選題：丙泊酚 + 瑞芬太尼��； 參考：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：評價(jià)一種Narcotrend指導(dǎo)下丙泊酚和瑞芬太尼聯(lián)合閉環(huán)靶控輸注的算法應(yīng)用于腹腔鏡膽囊切除術(shù)的可行性。方法：選擇擬在全麻下行腹腔鏡膽囊切除術(shù)的病人64例,年齡23～67歲,ASA I～Ⅱ級。采用隨機(jī)數(shù)字表法分為A組(n=32)和B組(n=32)。麻醉誘導(dǎo)：用兩臺Agilia TIVA注射泵分別采用Schnider、Minto模式靶控輸注丙泊酚和瑞芬太尼。A組先根據(jù)臨床經(jīng)驗(yàn)選擇丙泊酚初始靶濃度(Ceprop),然后按以下原則確定瑞芬太尼的初始靶濃度(Ceremi):如果Ceprop2.5 μg/ml,則Ceremi=3ng/ml;如果2.5 μg/ml≤Ceprop≤2.9 μg/ml, 則 Ceremi=3.5ng/ml;如果Ceprop2.9μg/ml,則Ceremi=4ng/ml。 B組全憑經(jīng)驗(yàn)確定丙泊酚和瑞芬太尼靶濃度。當(dāng)意識消失時給予順式阿曲庫銨015mg/kg, NI達(dá)到46時置入喉罩。麻醉維持：A組依據(jù)NI相關(guān)公式計(jì)算、B組依舊根據(jù)臨床經(jīng)驗(yàn),1次/5min調(diào)節(jié)靶濃度以維持NI在36左右。記錄丙泊酚和瑞芬太尼的誘導(dǎo)劑量,維持期平均劑量、充分麻醉(定義為N1在26～46)、麻醉過深(NI26)、麻醉過淺(NI46)所占的時間比和拔管時間(定義為從停止輸注丙泊酚到NI上升到80的時間)。分別于開始誘導(dǎo)即刻(TO),開始麻醉誘導(dǎo)后5min(T1),氣腹過程中各時點(diǎn)[包括氣腹即刻(T2),5min (T3), 10min (T4),15min (T5),結(jié)束即刻(T6),結(jié)束5min(T7)],術(shù)畢拔管即刻(T8)9個時間點(diǎn)的MAP、HR。結(jié)果：兩組的丙泊酚誘導(dǎo)劑量相似, A組的瑞芬太尼誘導(dǎo)劑量較多,誘導(dǎo)時間較短；維持期A組丙泊酚和瑞芬太尼平均劑量明顯減少(P0.05)、充分麻醉時間百分比明顯增加(P0.0001),麻醉過淺(P0.05)、麻醉過深(P＜0.0001)和蘇醒時間(P0.05)均明顯減少。T0-T1的MAP、HR均無明顯差異。T3-T5與對照組相比,A組的MAP和NI均顯著低于對照組(P0.05),T5的NI顯著低于對照組(P0.0001)。T6-T7兩組MAP呈下降趨勢,T6-T7A組的MAP均較低(P0.05),T6的MAP差異更加顯著(P0.05)。A組NI呈上升趨勢、對照組NI呈下降趨勢,T6的NIA組與對照組相比較高(P0.05)。T7-T8兩組MAP、HR和NI均呈上升趨勢,與對照組相比T8的MAP較低(P0.05),NI上升趨勢更為呈顯著(P0.05)。結(jié)論：這種Narcotrend指導(dǎo)下丙泊酚和瑞芬太尼聯(lián)合閉環(huán)靶控輸注的算法用于腹腔鏡膽囊切除術(shù),血流動力學(xué)更穩(wěn)定,麻醉深度更易維持,維持期丙泊酚和瑞芬太尼劑量減少,蘇醒時間縮短。
[Abstract]:Aim: to evaluate the feasibility of a closed loop target-controlled infusion of propofol and remifentanil under the guidance of Narcotrend for laparoscopic cholecystectomy. Methods: 64 patients, aged 2367 years, undergoing laparoscopic cholecystectomy under general anesthesia were selected. Group A and group B were randomly divided into two groups: group A (n = 32) and group B (n = 32). Anesthetic induction: two Agilia TIVA injection pumps were used for target-controlled infusion of propofol and remifentanil. Group A first selected the initial target concentration of propofol based on clinical experience, and then determined the initial target concentration of remifentanil according to the following principles Ceremio: if Ceprop2.5 渭 g / ml, then 3 ng / ml; if 2.5 渭 g/ml 鈮，

本文編號：1937631