文章摘要
不同血浆靶浓度舒芬太尼对腹腔镜气腹刺激时七氟醚MACBAR的影响
Effects of different target-controlled concentrations of sufentanil on MACBAR of sevoflurane in patients with carbon dioxide pneumoperitoneum stimulus
  
DOI：10.12089/jca.2020.01.011
中文关键词: 七氟醚；舒芬太尼  腹腔镜胆囊切除术  儿茶酚胺类
英文关键词: Sevoflurane  Sufentanil  Laparoscopic cholecystectomy  Catecholamines
基金项目:南充市市校科技战略合作项目(18SXHZ0161)
作者单位E-mail
郭艳霞 637000,四川省南充市,川北医学院附属医院麻醉科  
蒋萍萍 637000,四川省南充市,川北医学院附属医院麻醉科  
王丹 637000,四川省南充市,川北医学院附属医院麻醉科  
黄三 637000,四川省南充市,川北医学院附属医院麻醉科  
徐娟 637000,四川省南充市,川北医学院附属医院麻醉科  
杨小霖 川北医学院第二附属医院麻醉科 yang_xl_yang@126.com 
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中文摘要:
      
目的 观察不同血浆靶浓度舒芬太尼对腹腔镜手术患者气腹刺激时抑制50％患者交感肾上腺素能反应的七氟醚最低肺泡有效浓度(MACBAR)的影响。
方法 选择行腹腔镜胆囊切除术的患者125例,性别不限，年龄30～65岁,ASA Ⅰ或Ⅱ级,随机分为S0、S1、S2、S3、S4共五组,舒芬太尼血浆靶浓度分别为0、0.1、0.3、0.5、0.7 ng/ml。吸入七氟醚麻醉诱导,意识消失后,静脉注射罗库溴铵0.6 mg/kg完成喉罩置入,调节呼气末七氟醚浓度,靶控舒芬太尼,待呼气末七氟醚浓度达预设值并稳定15 min以上,建立气腹。采用序贯法测定5组七氟醚MACBAR值,同时测定患者气腹前后肾上腺素、去甲肾上腺素浓度。
结果 当静脉靶控输注0、0.1、0.3、0.5及0.7 ng/ml的舒芬太尼时,S0、S1、S2、S3和S4组七氟醚MACBAR值分别为（5.33±0.13）%、（4.53±0.08）%、（2.86±0.15）%、（2.23±0.10）%和（2.13±0.08）%。五组气腹刺激前后肾上腺素、去甲肾上腺素浓度差异无统计学意义。
结论 腹腔镜气腹刺激时七氟醚MACBAR随舒芬太尼血浆靶浓度的增加而降低,当舒芬太尼血浆靶浓度超过0.5 ng/ml时,七氟醚MACBAR值的下降出现封顶效应。当患者交感肾上腺素能反应被抑制时,血中肾上腺素、去甲肾上腺素浓度变化不受舒芬太尼血浆靶浓度的影响。
英文摘要:
      
Objective To observe the effects of different target plasma sufentanil concentrations on the minimum alveolar concentration (MAC) of sevoflurane for blocking adrenergicresponse (BAR) （MACBAR） in patients undergoing laporoscopic surgery with CO2 pneumoperitoneum stimulation.
Methods One hundred and twenty five patients undergoing laparoscopic cholecystectomy, regardless of gender, aged 18-65 years, falling into ASA physical status Ⅰ or Ⅱ category, were enrolled in this study. All the patients were randomly divided into 5 groups (S0, S1, S2, S3 and S4) with different sufentanil plasma target concentrations (0, 0.1, 0.3, 0.5 and 0.7 ng/ml). Anaesthesia was induced by multiple deep inhalation breaths of 8％ sevoflurane in 100％ oxygen till the patients were adequately clinically sedated, then 0.6 mg/kg of rocuronium was injected to facilitate the insertion of laryngeal mask airway. Sevoflurane and sufentanil were administered by the respective preset concentration in each group. The hemodynamic response to pneumoperitoneum stimulus was observed after the end-tidal sevoflurane concentrations had been maintained stable at least for 15 min. The MACBAR of sevoflurane was measured by the sequential method. Meanwhile, epinephrine and norepinephrine concentrations were also determined before and after pneumoperitoneum stimulus.
Results The base value of sevoflurane MACBAR in group S0, S1, S2, S3 and S4 were (5.33±0.13)％, （4.53±0.08）%， （2.86±0.15）%,（2.23±0.10）% and （2.13±0.08）% when 0, 0.1, 0.3, 0.5 and 0.7 ng/ml of sufentanil target controlled plasma concentration was used, respectively. But the decreased degree of sevoflurane MACBAR had no significant difference between the two groups of 0.5 ng/ml and 0.7 ng/ml of sufentanil plasma concentrations. No significant difference was found in the concentration of epinephrine or norepinephrine between before and after pneumoperitoneum stimulation in each group.
Conclusion Increasing sufentanil plasma target controlled concentration can decrease the MACBAR of sevoflurane. Celling effect of the decrease of sevoflurane’s MACBAR can occur when the sufentanil target-controlled concentration was higher than 0.5 ng/ml. When the sympathetic adrenergic response was suppressed in half of the patients in each group, the changes in plasma target concentration of sufentanil.
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