预先输注瑞芬太尼对异丙酚输注诱发肌阵挛现象的保护作用

发布时间：2018-03-14 12:20

本文选题：异丙酚　切入点：瑞芬太尼　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：观察异丙酚匀速输注诱发肌阵挛的现象的特点及预先注射瑞芬太尼对其的影响。方法：64名ASA分级Ⅰ～Ⅱ级,年龄18～40岁,在气管插管全麻下行择期手术的患者,随机分为C、R两组(n=32)。C组采用异丙酚以4000mg/h速度泵入,输注过程中予以BIS监测。直至BIS监测仪上的爆发抑制比(BSR)达到40%后停止试验。如果当异丙酚全部泵注完BSR值仍未达到40%,也停止实验,给予芬太尼和肌松药后插管。R组先靶控输注瑞芬太尼,输注过程中予以BIS监测。靶控设置：血浆靶控,Minto药代动力学参数,靶控浓度4ng/ml。待达到目标浓度继续输注10min后与C组一样将异丙酚以4000mg/h速度泵入,直至BIS监测仪上的爆发抑制比(BSR)达到40%后停止试验。试验期间观察患者是否出现肌阵挛现象及行肌阵挛严重程度分级,并判断患者出现肌阵挛现象时的意识状态。采用Marsh参数计算异丙酚匀速注射时效应室浓度变化。结果：C组有24例患者出现肌阵挛,其发生率为75%,R组患者则未见肌阵挛现象。C组24例患者出现肌阵挛时均已处于意识消失状态,此时BIS值为29.8±5.3,且22例先于脑电爆发抑制现象出现,2例后于其出现。另外当患者出现肌阵孪现象的异丙酚效应室浓度为5.28±1.75μg/ml,低于患者出现脑电爆发抑制时的效应室浓度p0.05)。结论：异丙酚匀速输注诱发肌阵挛现象时患者已处于一个较深的麻醉状态,且异丙酚诱发的肌阵挛现象与其诱发的脑电爆发抑制现象无关。在异丙酚输注前予以4ng/ml靶浓度的瑞芬太尼靶控输注可以有效地抑制肌阵挛现象的发生。
[Abstract]:Objective: To observe the characteristics of the phenomenon of myoclonus induced by propofol infusion and the effect of pre injection of remifentanil on it.
Methods: 64 patients of ASA grade I-II, age 18~40 years old, during tracheal intubation under general anesthesia were randomly divided into two groups of C, R (n=32).C group of propofol at the speed of 4000mg/h pump, BIS monitoring to lose in the process of injection. Until the outbreak of BIS monitor on the suppression ratio (BSR) reached 40% after the stop test. If all the infusion pump propofol BSR value has not yet reached 40%, also stop the experiment, fentanyl and muscle relaxants after intubation in group.R first target controlled infusion of remifentanil, BIS monitoring to lose in the process of injection. Setting: target controlled target controlled Minto, the pharmacokinetic parameters of target to reach the target controlled concentration 4ng/ml. concentration after 10min infusion and group C as propofol at the speed of 4000mg/h pump, until the outbreak of BIS monitor suppression ratio (BSR) reached 40% after the stop test. During the test were observed for severe myoclonus and myoclonus The degree of degree was graded and the conscious state of the patients with myoclonus was judged. The Marsh parameters were used to calculate the change of effect room concentration when propofol was injected at a constant rate.
Results: C group had 24 patients with myoclonus, the incidence rate was 75%, R group were not myoclonus in group.C 24 patients with myoclonic have lost consciousness in the state, and the BIS value is 29.8 + 5.3, and 22 cases before the EEG burst suppression phenomenon, 2 cases in the in addition. When the effect site concentration of propofol in patients with myoclonus phenomenon is 5.28 + 1.75 g/ml, lower than that of patients with EEG burst suppression effect when the chamber concentration of P0.05).
Conclusion: propofol infusion speed induced myoclonus phenomenon when patients have been in a deep anesthesia, and EEG myoclonus induced by propofol and induced burst suppression phenomenon. The 4ng/ml target concentration of remifentanil target in propofol infusion before controlled infusion can effectively inhibit the occurrence of myoclonus.

【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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