乳癌根治手术患者全麻维持期瑞芬太尼最佳输注速率的研究

目的:研究瑞芬太尼(remifentanil)不同输注速率对乳癌根治手术患者全麻维持期间血流动力学、HRV及BIS的影响,探讨瑞芬太尼在全麻维持期间的适宜输注速率。方法:选择20例全麻病人,年龄在32～66岁之间,无明显心血管疾病及重要脏器病变。全麻诱导药物为咪唑安定、瑞芬太尼、异丙酚、罗库溴胺。全麻维持为静吸复合麻醉,静脉药物采用瑞芬太尼,剂量从0.05μg/(kg·min)开始,以0.05μg/(kg·min)依次递加输注速率,每一速率维持10min,直至达到0.5μg/(kg·min),全程复合1.0MAC异氟醚吸入,间断追加维库溴胺维持肌松。记录术前、插管前即刻、插管后即刻、各种速率维持10min后及停止泵注后10min的心率(HR)、平均动脉压(MAP)、心率变异性(HRV、LF/HF)及脑电双频谱指数(BIS)。结果:全麻维持期间,瑞芬太尼输注大于0.2μg/(kg·min)后,随着输注速率的增加,血压、心率及LF/HF均为规律性下降,HRV呈不规则下降,差异有统计学意义(P<0.05)。停止泵注后心率、血压显著升高。麻醉诱导后BIS即快速下降,与诱导前比较有显著差异(P<0.01),与瑞芬太尼输注速度无明显关联,诱导后各时点比较差异无统计学意义(P>0.05)。结论:乳癌根治手术全麻维持期间,持续吸入1.0MAC异氟醚时,微量泵恒速输注瑞芬太尼0.2μg/(kg·min),既可达到有效的镇痛,同时对血流动力学影响较小。

Intra-operative optimal infusion rate of remifentanil for patients undergoing breast cancer radical operation

Objective ： To observe the different rates of remifentanil infusion on hemodynamics, HR, BP, HRV and bispectral index （BIS） in-patients undergoing breast cancer radical correction for investigating the optimal infusion rate on maintenance of anesthesia. Methods： Included in this study were 20 ASA Ⅰ-Ⅱ patients with an age range from 33 to 65. The anesthesia was induced with midazolam, propofol, remifentanil （2 μg/kg） or roeuronium and maintained with inhalation of isoflurenee （1 MAC） and continuous infusion of remifentanil at different rates immediately after intubation. Infusion rates of remifentanit began from 0.05 μg/（kg · min） and increased at 0.05 μg/（kg · min） per 10 min, with the peak of 0.5 μg/kg min. The data were kept concerning the HR, MAP, HRV, LF/HF and BIS at preoperative （ T1 ）, the moment before intubation（ T2 ） and after intubation （ T3 ） , the end of each infusion rate （ from T4 to T13 ） and 10 min after infusion withdrawal（T10）. After test, remifentanil or fcntanil was given to analgesia. If hypotension（ 〈 60 mmHg） and bradycardia （ 〈 55 bpm） happened, remifentanil infusion was withdrawn instantly,with atropine administration instead. Results：In maintenance of anesthesia,when remifentanil was given intravenously at the dose larger than 0.2 μg/（ kg · min） , the BP, HR and LF/HF dropped regularly but HRV decreased irregularly with the speed of infusion, which showed statistical difference （ P 〈 0. 05 ）. The BP elevated significantly upon the infusion withdrawal. The bisppectral index（BIS） fell rapidly after anesthesia induction as compared with pre-induction （ P 〈 0. 01 ）. There was no relationship to the speed of remifentanil infusion and no statistical difference in comparison with each point after induction （P 〉 0. 05 ） . Conclusion ： During the general anesthesia of patients undergoing breast cancer radical correction, continuous inhalation 1 MAC of isoflurane with infusion of remifentanil at dose