| 不同阿片类药物对意识消失时异丙酚用量及大脑皮质抑制速度和抑制程度的影响 |
| 投稿时间：2014-07-30 修订日期：2014-09-03 点此下载全文 |
| 引用本文：张国华,孙莉.不同阿片类药物对意识消失时异丙酚用量及大脑皮质抑制速度和抑制程度的影响[J].医学研究杂志,2015,44(3):63-67 |
| DOI：
10.3969/j.issn.1673-548X.2015.03.018 |
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| 基金项目:中国癌症基金会北京希望马拉松基金资助项目(LC2011B30) |
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| 中文摘要:目的 探讨不同阿片类药物对意识消失时异丙酚用量及大脑皮质抑制速度和抑制程度的影响。方法 选择ASAⅠ~Ⅱ级、年龄为18~60岁、拟全身麻醉下行乳癌根治术的女性患者60例, 随机平均分为4组:P组(异丙酚)、FP组(芬太尼+异丙酚)、SP组(舒芬太尼+异丙酚)和RP组(瑞芬太尼+异丙酚);分别给予生理盐水、芬太尼2μg/kg、舒芬太尼0.2μg/kg和瑞芬太尼2μg/kg, 而后给予持续静脉滴注异丙酚100mg/min直至患者意识消失。脑电双频谱指数(BIS)监测大脑皮质抑制状态。记录患者意识消失的时间和BIS值、 BIS值达到60的时间(BIS60)、BIS最低值及其出现的时间;并计算各组异丙酚的用量, 同时分析异丙酚用量与BIS最低值的相关性。结果 3组阿片类药物/异丙酚组合的意识消失时间均明显缩短(P组:93±14s;FP组:76±11s;SP组:62±10s;RP组:72±14s), 意识消失时的BIS值均明显增高(P组:57±6;FP组:80±5;SP组:81±2;RP组:80±3)(P组与FP、SP、RP组相比较, P均<0.05);SP组BIS60的时间(83±14s)明显短于FP组(96±11s)和RP组(95±13s), SP组BIS最低值(40±3)明显高于FP组(32±3)和RP组(30±3), SP组异丙酚用量(1.64±0.42mg/kg)明显低于FP组(1.99±0.24mg/kg)和RP组(1.99±0.53mg/kg)(SP组与FP、RP组相比较, P均<0.05);异丙酚用量与BIS最低值在SP组(r=-0.98)、FP组(r=-0.99)和RP组(r=-0.99)组均呈显著负相关。结论 在以BIS作为大脑皮质抑制状态的监测指标时, 达到意识消失剂量的芬太尼/异丙酚、瑞芬太尼/异丙酚和舒芬太尼/异丙酚3种组合相比较, 舒芬太尼/异丙酚组合对大脑皮质的抑制速度较快, 但对大脑皮质的最大抑制程度较低。提示阿片类药物与异丙酚联合诱导时, 不能通过患者意识消失的速度来预测可能达到的最大镇静深度。 |
| 中文关键词:脑电双频谱指数 异丙酚 芬太尼 瑞芬太尼 舒芬太尼 |
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| Effects of Different Opioids on Propofol Consumption to Loss of Consciousness and on Rate and Depth of Cerebral Cortex Suppression |
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| Abstract:Objective To investigate the effects of fentanyl, sufentanil and remifentanil combined propofol at doses to loss of consciousness on rate and extent of cerebral cortical suppression. Methods Sixty patients, ASAⅠ-Ⅱ, aged 18-60 years, scheduled for radical mastectomy were enrolled in the study. These patients were randomly allocated into four groups, group P(propofol only), group FP(fentanyl+propofol), group SP(sufentanil+propofol) and group RP (remifentanil+propofol). Normal saline, fentanyl 2μg/kg, sufentanil 0.2μg/kg and remifentanil 2μg/kg were given initially in groups P, FP, SP and RP, respectively. After bolus of opioids, propofol was infused at a constant rate of 100mg/min until loss of consciousness. Bispectral index (BIS) monitor was used to assess the cerebral cortical inhibition. Time to loss of consciousness (LOC), BIS values at LOC, time to BIS value of 60(BIS60), the lowest BIS values and time to those were all recorded. The propofol consumptions were calculated and the correlation between propofol doses and the lowest BIS values was analyzed for each group. Results Time to LOC(P group:93±14s;FP group:76±11s;SP group:62±10s;RP group:72±14s)was significantly shortened and BIS values at LOC(P group:57±6;FP group:80±5;SP group:81±2;RP group:80±3) were significantly higher in the opioid/propofol groups compared to group P (P<0.05, repectively). Time to BIS60 was shorter in group SP(83±14s)than in groups FP(96±11s)and RP(95±13s)(P<0.05, repectively).The lowest BIS value was higher in group SP(40±3)than in groups FP(32±3)and RP(30±3)(P<0.05, repectively).The consumption of propofol was lower in group SP(1.64±0.42mg/kg)than in groups FP(1.99±0.24mg/kg)and group RP(1.99±0.53mg/kg)(P<0.05, repectively). The correlation between propofol doses and the lowest BIS values was negatively significant in groups FP(r=-0.99), SP(r=-0.98) and RP(r=-0.99). Conclusion When BIS was used to monitor cerebral cortical suppression, the sufentanil/propofol combination produced more rapid but less great suppression on cerebral cortex compared with fentanyl/propofol and remifentanil/propofol combinations if these three opioids/propofol combinations were given at doses to loss of consciousness. This suggests that when induced with opioids and propofol, the rate of loss of consciousness may not be used to predict the maximum depth of sedation. |
| keywords:Bispectral index Propofol Fentanyl Remifentanil Sufentanil |
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