《中国康复理论与实践》

《中国康复理论与实践》 ›› 2007, Vol. 13 ›› Issue (08): 759-761.

• 临床研究 • 上一篇    下一篇

舒芬太尼对清醒或异丙酚镇静患者自主呼吸的抑制作用

李淑琴; 董佳; 王保国   

  1. 首都医科大学附属北京天坛医院麻醉科,北京市 100050
  • 收稿日期:2007-04-11 出版日期:2007-08-01 发布日期:2007-08-01

Respiratory Depression of Sufentanil to Patients with or without Propofol Sedation

LI Shu-qin, DONG Jia, WANG Bao-guo   

  1. The Department of Anesthesiology, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China
  • Received:2007-04-11 Published:2007-08-01 Online:2007-08-01

PDF (PC)

摘要： 目的观察使用或不使用异丙酚镇静时,不同血浆靶控浓度舒芬太尼对呼吸的影响。方法40例进行择期神经外科手术的患者随机分为单纯舒芬太尼组(S组)和舒芬太尼联合异丙酚组(SP组),每组20例。SP组先以血浆靶浓度2μg/ml靶控输注异丙酚,达到靶浓度后维持并开始从血浆靶浓度0.2ng/ml起,以0.2ng/ml为梯度进行舒芬太尼靶控输注,而S组直接进行舒芬太尼靶控输注,两组均每3min增加舒芬太尼的血浆靶浓度1次,观察呼吸频率(RR)、分钟通气量(MV)、呼气末CO2分压(PET-CO2)、脉搏血氧饱和度(SpO2)等参数变化,同时观察平均动脉压(MAP)、心率(HR)等循环指标并进行警觉/镇静评分(OAA/S)。将出现肌僵直、RR<6次/min、MV<3L、PETCO2>55mmHg、SpO2<90%、呼吸暂停>15s等作为出现呼吸抑制、终止舒芬太尼靶控输注的指标。结果随舒芬太尼血浆靶浓度增加,两组患者的RR、MV降低,PETCO2升高(P<0.05);两组患者的抑制自主呼吸的舒芬太尼效应室浓度计算值分别为(0.46±0.14)ng/ml和(0.23±0.06)ng/ml,差异有非常显著性意义(P<0.01)。结论应用舒芬太尼靶控输注时,随靶浓度增加舒芬太尼自主呼吸抑制的作用逐渐增强;在异丙酚镇静基础上应用舒芬太尼时,两者的呼吸抑制可呈协同作用。

关键词: 舒芬太尼, 异丙酚, 靶控输注, 呼吸抑制

Abstract: Objective To observe the respiratory depression of sufentanil with target-controlled infusion under propofol sedation or not.Methods40 patients, ASAⅠ or Ⅱ, scheduled for selective neurosurgery were randomly divided into the sufentanil group (group S) and the combined group (group SP) with 20 cases in each group. In the group SP, sedation was maintained with target-controlled infusion of propofol by plasmas concentration of 2 μg/ml. Target-controlled infusion of sufentanil was performed at the initial plasma concentration (Cp) of 0.2 ng/ml, and increased in a increment of 0.2 ng/ml at 3 minutes interval; while in the group S, only the infusion of sufentanil was performed. The respiratory rate (RR), minute ventilation (MV), partial pressure of end-tidal carbondioxide (PETCO2), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), Observer's Assessment of Alertness/Sedation (OAA/S) were measured and respiratory depression was defined as one of the following end points were achieved: muscle rigidity, RR<6 bpm, MV<3 L/min, PETCO2>55 mmHg, SpO2<90% or apnea>15 s.ResultsThe RR, MV of patients in two groups decreased and PETCO2 increased significantly as increase of Ce ( P<0.05). The calculated effect site concentration (Ce) of sufentanil for respiratory depression was (0.46±0.14)ng/ml in the group S and (0.23±0.06)ng/ml in the group SP having a significant difference between two groups ( P<0.01).ConclusionSufentanil can dose-dependently suppress spontaneous respiration.

Key words: sufentanil, propofol, target-controlled infusion, respiratory depression