异丙酚和尼卡地平在眼科手术病人围拔管期应用的比较

Effects of Propofol versus Nicadipine on Inhibiting Hemodynamic and Stress during Emergence and Extubation for Ophthalmic Patients

【目的】观察气管拔管前静脉注射异丙酚和尼卡地平对眼科全麻手术病人拔管反应的影响。【方法】选择60例眼科手术全麻病人随机分为A、B、C 3组(n=20),分别于气管拔管前静脉注射异丙酚1.5 mg/kg、尼卡地平20μg/k和生理盐水,分析比较各组拔管期间心血管反应、躁动、呛咳等并发症,眼压的变化以及苏醒时间的差异。【结果】A组吸痰、拔管时和拔管后心率、血压与诱导前比较无明显差异,与用药前相比均明显下降(P< 0.05),与对照组同时点比较,明显下降(P<0.05);B组吸痰、拔管时血压与诱导前比较无明显升高,与用药前比较明显下降(P<0.05),与对照组同时点比较,明显下降(P<0.05);B组和C组同时点心率与用药前比较无明显下降。B组心率与诱导前比较明显升高;C组吸痰、拔管时及拔管后2 min血压与用药前比较无明显下降。拔管期间以及拔管后A组呛咳及躁动的发生率明显低于B、C组(P<0.05);3组均无喉痉挛患者出现;舌后坠发生率A组略高于B、C组,但无明显差异。患者清醒时间3组无显著性差异(P>0.05);拔管时A组眼压与诱导前比较无明显升高,其他两组则有明显升高(P<0.05)。【结论】眼科手术病人气管拔管前应用镇静剂异丙酚预防拔管反应效果优于尼卡地平,且不影响患者苏醒时间。

[Objective]To compare propofol versus nicadipine to control hemodynamic and stress responses to emergence and extubation for the ophthalmic patients.[Methods]Sixty ASA grade Ⅰ-Ⅱ patients scheduled for eye surgery under general anesthesia were randomly divided into 3 groups (n=20). The patients in each group were given intravenously different drug before extubation: group A with 1.5mg/kg propofol, group B with 20μg/kg nicadipine and group C with 8 ml normal saline (NS). The blood pressure (BP), heart rate (HR) and the rates of bulking cough, laryngeal spasm, and agitation before and after extubation in 3 groups were recorded. The recovery time and IOP changes were also compared among 3 groups. [Result]In group A, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P<0.05), and had significant difference compared with group C (P<0.05). Compared to preinduction, the BP of group B showed no obvious increase during aspiration and extubation, while it was significantly lower than that before giving nicadipine (P<0.05), and it had significant difference compared with group C (P<0.05). The HR of group B and C had little changes after giving nicadipine and NS, and the HR of group B showed obviously increase compared with that before induction. In group C, the high BP lasted until 5 minutes after extubation. The stimulation of aspiration and extubation caused less bulking cough, agitation in group A than group B and C (P<0.05). There were no episodes of hypotension, laryngeal spasm, or severe respiratory depression happened. There was no statistic difference in recovery time among three groups (P>0.05).The IOP of group A showed no obvious increase during extubation compared with that before induction,while in the other groups, extubation caused IOP significant increase (P<0.05). [Conclusions]Compared to nicadipine, propofol is superior for preventing the cardiovascular and stress responses and IOP increase during emergence and extubation for the ophthalmic patient, and have no effects on patient recovery.