国际麻醉学与复苏杂志   2012, Issue (9): 6-6
    
效应室靶控输注舒芬太尼在腹腔镜胆囊切除术中的应用
屈罡升, 贺振秋, 马雪松, 李军, 戚思华1()
1.哈尔滨医科大学附属四院
The application of sufentanil by effect compartment-controlled target-controlled infusion during laparoscopic cholecystectomy
 全文:
摘要：

目的 研究效应室靶控输注（target-controlled infusion, TCI）舒芬太尼在腹腔镜胆囊切除术中的应用，探讨合适的TCI浓度。方法 择期行腹腔镜胆囊切除术患者75例，按照随机数字表法分为5组(每组15例)：舒芬太尼效应室TCI浓度0.2 μg/L组(A组)、0.3 μg/L 组(B组)、0.4 μg/L组(C组)、0.5 μg/L组(D组)和芬太尼静脉推注3 μg/kg 组(E组)。依据平均动脉压(MAP)、心率(HR)、Narcotrend指数(narcotrend index, NI)指导血管活性药物的使用及丙泊酚TCI浓度的调节。于诱导前(T0)、喉罩置入前即刻（T1）喉罩置入后即刻(T2)、喉罩置入后5 min (T3)、手术开始(T4)、气腹建立(T5)、开始游离胆囊(T6)、胆囊动脉游离完毕(T7)、切下胆囊(T8)、术毕(T9)、睁眼 (T10)、拔出喉罩(T11)及离室(T12)记录MAP、HR和NI值；记录血管活性药使用情况及术中丙泊酚调节次数；记录术毕至患者清醒时间。结果 T1、T2、T3较T0时间点各组MAP和HR均明显下降(P<0.05)，其中A组3个时间点MAP分别为（75±6）、（79±7）、（75±6）mm Hg（1 mm Hg=0.133 kPa），与其他各组比较下降幅度最小；与T0比较，T6时间点各组MAP均升高(P<0.05)，在T6时间点A、B组MAP分别为（117±11）、（114±13）mm Hg，显著高于C组(P<0.05)；在T11点，B、C、D组MAP和HR低于E组（P<0.05）；术中C组丙泊酚调节（2.5±0.6）次，在所有组别中最少且未使用血管活性药物，与A、B、E组比较有统计学差异(P<0.05)；D组患者苏醒时间为（13.3±3.4）min，与E组患者比较明显延长(P<0.05)。结论 效应室TCI舒芬太尼可有效地应用于腹腔镜胆囊切除手术，较适诱导和较适维持浓度分别为0.2 、0.4 μg/L。
关键词： 舒芬太尼； 靶控输注； 腹腔镜胆囊切除术
Abstract:

 Objective To study the application of sufentanil by effect compartment-controlled target-controlled infusion （TCI） during laparoscopic cholecystectomy (LC), investigate the appropriate TCI concentration. Methods 75 patients undergoing laparoscopic cholecystectomy were randomly divided into 5 groups (n = 15): sufentanil effect compartment concentration 0.2 μg/L (group A), 0.3 μg/L (group B), 0.4 μg/L (group C) and 0.5 μg/L (group D), fentanyl 3 μg/L i.v. (group E). The concentration of propofol and the use of vasoactive drug were directed by MAP, HR and Narcotrend index (NI). MAP and HR were recorded at the time points of before anesthesia induction (T0), immediately before and after LMA-Supreme™ insertion (T1-2), 5min after LMA-Supreme™ insertion (T3), beginning of surgery (T4), establishment of pneumoperitoneum (T5), beginning of freeing the gallbladder (T6), end of freeing cystic artery (T7), cutting the gallbladder (T8), end of surgery (T9), eyes opening (T10), pulling out the laryngeal mask (T11), leaving off the operating room (T12 ). The use of vasoactive drug, times of adjusting propofol, awakening time, side effects were recorded. Results MAP and HR were significantly decreased at T1-3 compared with the baseline at T0 in all groups (p<0.05). The MAP at T1-3 in group A were （75±6）,（79±7）,（75±6）mm Hg（1 mm Hg=0.133 kPa）respectively, and changed lighter than that in other groups. Compared with MAP at T0, there was significantly increase at T6 in all groups. The MAP at T6 in group A and B were （117±11）and（114±13）mm Hg respectively, and higher than that in group C (p<0.05); Both MAP and HR in group B, C and D were significantly decreased at T11 compared with that in group E(p<0.05). In group C, the times of altering propofol with（2.5±0.6） was less than that in other groups. The awakening time in group D with （13.3±3.4） was longer than that in group E (p<0.05). Conclusions Sufentanil by effect compartment-controlled TCI is used well in laparoscopic cholecystectomy, the most appropriate induction and maintenance concentrations were 0.2 μg/L and 0.4 μg/L respectively.
Key words: Sufentanil； Target-controlled infusion ； Laparoscopic cholecystectomy