右美托咪啶复合丙泊酚靶控输注对喉罩置入条件的影响

中国临床药理学与治疗学 ›› 2013, Vol. 18 ›› Issue (2): 186-189.

右美托咪啶复合丙泊酚靶控输注对喉罩置入条件的影响

仲俊峰, 胡双燕, 李玉红, 陈念平

浙江省绍兴市人民医院麻醉科,绍兴 312000,浙江

收稿日期:2012-08-28 修回日期:2012-08-28 发布日期:2013-02-28
通讯作者: 李玉红,通信作者,女,博士,副主任医师,研究方向:麻醉药理及液体治疗。 Tel: 0575-88229212 E-mail: yuh_li@qq.com
作者简介:仲俊峰,男,主治医师,从事临床麻醉工作。 Tel: 13777312712 E-mail: zhongjunfeng800@126.com
基金资助:
浙江省医学会临床科研基金(2011ZYC-A88)

Laryngeal mask insertion conditions at different target plasma concentrations of propofol combined with dexmedetomidine

ZHONG Jun-feng, HU Shuang-yan, LI Yu-hong, CHEN Nian-ping

Department of Anesthesiology,Shaoxing People's Hospital, Shaoxing 312000, Zhejiang,China

Received:2012-08-28 Revised:2012-08-28 Published:2013-02-28

摘要/Abstract

摘要： 目的: 比较右美托咪啶(Dex)复合丙泊酚不同血浆靶浓度靶控输注(TCI)诱导时喉罩置入条件,探讨喉罩置入时右美托咪啶复合丙泊酚靶控输注的合适靶浓度。方法: 择期行短小手术患者 75例,年龄 20~60岁,ASAI-II级,随机分为三组(n=25),I、II、III组丙泊酚靶浓度分别为 2.0、2.5、3.0 μg/mL。右美托咪啶 0.6 μg/kg 负荷量 10 min 泵完,当丙泊酚效应室浓度(Ce)达预设靶浓度 3 min后置入喉罩,观察喉罩置入条件:下颌活动度、呛咳、体动及喉痉挛。记录患者术前 (T₀)、喉罩置入前(T₁)、置入后 1 min(T₂)、3 min(T₃)时收缩压(SBP)、平均动脉压(MAP)、心率(HR)及脑电双频谱指数 (BIS)。计算 T₀和T₁时 SBP、MAP、HR的变化幅度。记录各组呼吸抑制例数、时间。记录各组麻黄素和阿托品使用情况。结果: 各组 T₁~T₃ SBP、MAP、HR均低于 T₀ (P<0.05),与I、II 组相比,III组下降幅度更明显 (P<0.05)。与 T₁比较,三组 T₂时的SBP、MAP和 HR没有出现明显的变化 (P>0.05)。三组 BIS差异无统计学意义(P>0.05)。喉罩置入条件 I组有 3例张口度差,5例发生呛咳或体动,与II、III组比较差异有统计学意义(P<0.05),II、III组间差异无统计学意义(P>0.05)。与 I、II 组相比,III组呼吸抑制例数增加和抑制时间延长(P<0.05),而且 III组有更多患者需要使用麻黄素、阿托品(P<0.05)。结论: 右美托咪啶 0.6 μg/kg 复合丙泊酚靶浓度 2.5 μg/mL 能够提供足够的麻醉深度和良好的喉罩置入条件,不会产生明显的呼吸和循环抑制作用。

关键词: 丙泊酚, 右美托咪定, 靶控输注, 喉罩

Abstract: AIM: To compare the laryngeal mask insertion conditions at different plasma target concentrations (Cp) during the induction of anesthesia with target-controlled infusion (TCI) of propofol combined with dexmedetomidine. METHODS: Seventy-five ASA I-II patients of both sexes aged 20-60 years, weighing 50-80 kg, in which the use of laryngeal mask was indicated were randomly divided into 3 groups (n=25) according to Cp of propofol set during induction of anesthesia: 2.0, 2.5 and 3.0 μg/mL.Dexmedetomidine 0.6 μg/kg was infused over 10 minitues. Then,TCI propofol was given by Diprifusor (Graseby 3500 infusion pump).Laryngeal mask was inserted when the effect-site concentration (Ce) of propofol reached the settled Cp. Laryngeal mask insertion conditions (jaw mobility,coughing,head and limb movement,laryngeal spasm) were assessed. SBP, MAP, HR and BIS value were recorded at four time points:baseline before induction (T₀), instant before laryngeal mask inserted (T₁), 1 min (T₂) and 3 min (T₃) after insertion of laryngeal mask. Changes of SBP, MAP and HR between T₁ and T₀ were calculated. The number of patients with apnea and apnea times were recorded. The administration of atropine and ephedrine was also recorded. RESULTS: The levels of SBP, MAP and HR were decreased with increasing depth of anesthesia in the 3 groups.The decline rates of SBP, MAP and HR after induction had significantly differences in group III than those in group I and II (P<0.05). BIS value was similar in all groups. The insertion conditions were significantly better in group II and III than that in group I. More patients developed apnoea and their apnoea times were longer in group III than the other two groups (P<0.05). More patients were administrated with atropine and ephedrine in group III compared with the other two groups (P<0.05).CONCLUSION: Induction of anesthesia with dexmedetomidine 0.6 μg/kg combined with TCI of propofol with Cp set at 2.5 μg/mL is satisfactory for laryngeal mask insertion in terms of cardiovascular stability and insertion conditions.

Key words: Propofol, Dexmedetomidine, Target-controlled infusion, Laryngeal masks

中图分类号:

R614

仲俊峰, 胡双燕, 李玉红, 陈念平. 右美托咪啶复合丙泊酚靶控输注对喉罩置入条件的影响[J]. 中国临床药理学与治疗学, 2013, 18(2): 186-189.

ZHONG Jun-feng, HU Shuang-yan, LI Yu-hong, CHEN Nian-ping. Laryngeal mask insertion conditions at different target plasma concentrations of propofol combined with dexmedetomidine[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(2): 186-189.

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