康力+刘华+吕东森+周骞+刘焕结+罗芬+邝永燕

[摘要] 目的 观察静脉复合全麻中瑞芬太尼维持用药量与诱导中使用或不使用阿托品的关系。 方法 选择接受腹部及四肢择期手术治疗实施气管插管全麻患者40例，随机分为为A组和B组，每组各20例。两组全麻维持用药方法均为：恒速泵注丙泊酚4mg/（kg·h），调节瑞芬太尼泵注剂量[起始剂量60?g/（kg·h）]在手术开始后15min内控制并维持MAP比基础MAP低5%左右（0～10%），并持续到手术结束。两组全麻诱导用药均为：瑞芬太尼10?g/kg、依托咪酯0.3mg/kg、维库溴铵0.12mg/kg。A组诱导静注阿托品0.007mg/kg，B组诱导不用阿托品。 结果 两组麻醉中维持MAP降低幅度均达到计划目标，组间差异无统计学意义（P>0.05）；两组全麻维持效果评级均为Ⅱ级；两组均未出现术中知晓；全麻维持中A组瑞芬太尼用量（52.34±6.85）?g/（kg·h）显著高于B组（39.91±11.12）?g/（kg·h）（P<0.01）。 结论 在瑞芬太尼、丙泊酚静脉复合全麻维持中，达到了相同全麻维持效果，瑞芬太尼的维持用量因诱導中不使用阿托品而有所减少，麻醉药物费用减少，从而减轻患者经济负担，也节约了医保资金。

[关键词] 全麻维持中；瑞芬太尼维持用量；阿托品；诱导

[中图分类号] R614.2 [文献标识码] A [文章编号] 2095-0616（2017）20-170-04

The relationship between the maintenance dose of remifentanil in intravenous combined general anesthesia and use or not use atropine in induction

KANG Li LIU Hua LU Dongsen ZHOU Qian LIU Huanjie LUO Fen

KUANG Yongyan

Department of Anesthsia，Bao'an District Hospital of Traditional Chinese Medicine，Shenzhen 518133，China

[Abstract] Objective To observe the relationship between the maintenance dose of remifentanil in intravenous combined general anesthesia and use or not use atropine in induction. Methods 40 cases Acceptived abdominal and limb elective surgery with endotracheal intubation ender general anesthesia were selected and randomly divided into group A and group B with 20 cases in each.Two groups of general anesthesia maintenance methods were consistent：propofol was pumped by constant speed with 4mg/（kg·h），the remifentanil injection dose was adjusted[starting dose 60?g/（kg·h）]，controling and maintaining of MAP was less than 5%（0-10%） in basic MAP Within 15 minutes after the start of surgery and continued until the end of the procedure.The 2 groups were administered for the induction of general anesthesia：Remifentanil 10?g/kg，etomidate 0.3mg/kg，vecuronium 0.12mg/kg.Group A was induced by intravenous injection of atropine 0.007mg/kg，Group B was induced without atropine. Results Maintenance MAP reductions in two groups of anesthesia had achieved planned targets，there was no significant difference between groups（P>0.05）；Two groups of general anesthesia maintenance effect rating was II；There was no intraoperative awareness found in the two groups；In general anesthesia maintenance，the remifentanil dosage（52.34±6.85）μg/（kg·h） in group A was significantly higher than that in group B（39.91±11.12）μg/（kg·h）（P<0.01）. Conclusion In the maintenance of remifentanil and propofol intravenous anesthesia，the same general anesthesia maintenance effect has achieved，and the maintenance dose of remifentanil has decrease due to the absence of atropine，it dose reduce anesthetic costs，thus reducing the patients financial burden，but also saving the medical insurance funds.endprint

[Key words] General anesthesia maintenance； Maintenance dose of remifentanil； Atropine；Induce

阿托品是一种胆碱能受体阻断药，其本身并不具有镇静或者镇痛作用，通常在麻醉或手术导致心

跳过缓时应用以提升心率。文献报道[1]对ASAⅠ级或Ⅱ级的无高血的中青年患者实施腹腔器官、四肢、脊柱择期手术，使用依托咪酯0.3mg/g、瑞芬太尼15?g/kg配伍诱导中，心率必定会减慢到50次/min以下，诱导中必须使用阿托品，所以使用15?g/kg的瑞芬太尼诱导，是无法观察诱导中使用与不使用阿托品对全麻维持中瑞芬太尼用量的影响。但使用瑞芬太尼10?g/kg诱导时，心率不会减慢到60次/min以下，故阿托品可以使用，也可以不使用。瑞芬太尼配伍依托咪酯全麻诱导中使用阿托品可减轻气管插管前MAP降低的幅度，却不影响抑制气管插管反应的效果[2]，诱导插管过程中血流动力学更加平稳。全麻……