意识指数2与瑞芬太尼剂量在无痛胃镜中的关系

发布时间：2018-04-29 02:23

本文选题：意识指数 + 瑞芬太尼　；参考：《广东医学》2017年08期

【摘要】：目的探讨意识指数2(IOC2)监测与瑞芬太尼在无痛胃镜检查中的相关性。方法择期行无痛胃镜检查患者80例,按数字表法随机分为C组和R2、R4、R6组,每组20例。麻醉诱导:C组采用静脉推注丙泊酚1.5~2.5 mg/kg(0.3 mL/s),R2、R4、R6组在输注丙泊酚同时分别靶控输注2、4、6 ng/mL瑞芬太尼(MINTO模型,血浆浓度),到达目标浓度后停止输注该药。各组麻醉维持均为持续输注丙泊酚4~12 mg/(kg·h),IOC1维持于40~60时开始胃镜检查。术中心率(HR)、平均动脉压(MAP)高于基础值20%或发生体动反应时,单次追加丙泊酚20~40 mg,必要时给予乌拉地尔10~20 mg,HR、MAP低于基础值20%时予加快输液及减小丙泊酚输注速率,必要时给予阿托品0.5 mg或麻黄碱5~15 mg,所有患者脉搏血氧饱和度(SpO_2)低于95%时行下颌关节托举,SpO_2持续低于90%超过2 min时停止所有操作,行面罩吸氧及手控辅助呼吸。记录各组患者术前(T1)、镜检开始(T2)、镜检结束(T3)及术毕5 min(T4)的IOC1和IOC2,并记录IOC2最低值和起效时间(麻醉诱导开始到IOC2下降至最低值)、围术期低血压、高血压、心动过缓、心动过速、低氧血症、体动反应发生情况、丙泊酚用量及苏醒时间。结果随着瑞芬太尼剂量增加,R4和R6组丙泊酚用量减少、苏醒时间缩短、IOC2最低值变小,起效时间较短(P0.05),IOC2最低值与瑞芬太尼浓度呈负相关,其相关系数为-0.297。结论 IOC2与瑞芬太尼呈负相关,随着瑞芬太尼剂量增加,起效时间缩短。
[Abstract]:Objective to investigate the correlation between consciousness index 2 IOC 2 and remifentanil in painless gastroscopy. Methods Eighty patients with painless gastroscopy were randomly divided into group C (n = 20) and group R _ 2 (n = 20). Anesthesia induced group C was treated with propofol 1.5 mg/kg(0.3 / L and 2.5 mg/kg(0.3 / ml / L / L R2P / R _ 4 / R _ 4 / R _ (6) group respectively. The plasma concentration of propofol was reduced after the injection of propofol was controlled at the same time by target-controlled infusion of 2 ng/mL remifentanil and MINTO model. The plasma concentration of propofol was up to the target concentration and the infusion was stopped after the injection of propofol. The maintenance of anesthesia was continuous infusion of propofol for 12 mg/(kg and IOC1 was maintained at 40 ~ 60. During the operation, the heart rate and mean arterial pressure (MAPP) were 20% higher than the basic value or 40 mg of propofol 20 mg, and when Urapidil 1020 mg HRMAP was given lower than the basic value 20%, the infusion rate of propofol was decreased and the infusion rate of propofol was decreased. All patients were given atropine 0.5 mg or ephedrine 5 mg or ephedrine 15 mg if necessary. All patients were treated with SPO _ 2 (pulse oxygen saturation) < 95%. All operations were stopped when the mandibular joint lift SpO-2 remained below 90% or more than 2 min, mask oxygen inhalation and manual assisted respiration were performed. The IOC1 and IOC2 of the patients in each group were recorded before operation (T _ 1, T _ 2, T _ 3, T _ 3) and 5 min after operation, and the minimum value and onset time of IOC2 (from induction of anesthesia to the lowest value of IOC2, perioperative hypotension, hypertension, bradycardia, tachycardia) were recorded. Hypoxemia, body movement, propofol dosage and recovery time. Results with the increase of remifentanil dosage, the dosage of propofol decreased, the minimum value of IOC2 decreased, and the lowest value of IOC2 was negatively correlated with the concentration of remifentanil. The correlation coefficient was -0.297. Conclusion there is a negative correlation between IOC2 and remifentanil, and the onset time is shortened with the increase of remifentanil dosage.
【作者单位】：深圳市第三人民医院麻醉科;
【分类号】：R614

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