高血压病患者术中应用丙泊酚自控镇静术的观察

Application of controlled sedation with propofol during operation in patients with hypertension.

目的 观察在高血压病患者术中丙泊酚自控镇静术 (PCS)的临床应用效果。方法 选择 4 0例高血压病患者 ,随机分为PCS组 (n =2 0 )和对照组 (n =2 0 ) ,连硬外麻醉 ,平面均在T6以下 ,PCS组应用GrasebyPCA注射泵静脉输注 ,采用模式 :负荷量 0 .5mg/kg +PCS剂量 1次 1ml(8mg丙泊酚生理盐水混合液 ) ,锁定时间 2min ,术中观察患者镇静效果、血流动力学指标、对呼吸影响、患者满意度及其合作的程度。结果 PCS组Ramsay在Ⅱ～Ⅳ级占 90 % ,对照组 4 0 % ;患者满意程度PCS组 3分占 95 % ,对照组 5 0 % ;循环功能 :PCS组术中 30min与用药前比平均动脉压、心率有极显著差异 (P <0 .0 1 ) ;两组呼吸影响无显著性差异。结论 丙泊酚用于高血压病患者术中镇静、降压效果好 。

Objective To study the effects of patient controlled sedation (PCS) induced by propofol on hemodynamics during operation in patients with hypertension. Methods 40 hypertension patients were randomly divided into two groups: PCS group ( n =20) and control group ( n =20). All patients underwent the operation by injecting propofol using Graseby Patient Controlling Analgesia pump, load dosage 0.5 mg/kg and patient control dosage (8 mg propofol). 1 ml volume content and lock time 1 min were set. The sedation degree (by Ramsay scale), and changes of hemodynamics were observed. The degree of patients' content and cooperation were recorded.Results Ramsay Ⅱ～Ⅳ grade in PCS group took 90 %, while it took 40 % in control group. Sedation score was up to 3 in 95 % patients of PCS group, while only in 50 % of control group. There was significant difference in mean artery pressure and HR between two groups ( P < 0.01 ), but there was no significant difference in pulmonary function.Conclusion PCS with propofol can produce satisfied sedation in patients with hypertension. During operation, PCS with propofol can decrease the blood pressure to a safe level, with least drug, and make the patient more confortable.