微量泵输注异丙酚应用于重症肌无力胸腺瘤切除的麻醉体会

Anesthesia Experience of Propofol Infusion in Minim Pump Applied in Thymectomy for Myasthenia Gravis ( MG )

目的:观察采用微量泵输注异丙酚在重症肌无力胸腺瘤切除术的临床应用。方法:24例ASAⅠ～Ⅱ级,胸腺瘤伴重症肌无力(MG)患者行胸腺瘤切除,随机分为两组A组和B组,均采用慢诱导气管内全麻;麻醉维持:A组以吸入(2～3)%氨氟醚和间断静注芬太尼。B组:微量泵持续输注异丙酚6～9mg/kg/h,和间断静注芬太尼。术中酌情给予小剂量卡肌宁。术中监测血流动力学变化。结果:B组病人整个麻醉手术中血流动力学稳定,(P>0.05),苏醒明显快于A组,术后4小时绝大多数病人镇静程度为2或3级。而A组病人气管插管及切皮时MAP显著升高(P<0.05),插管时HR变化显著(P<0.01)。结论:采用微量泵连续静脉给药可使血药浓度维持相对稳定状态,使麻醉平稳,顺利。病人苏醒快,拔管早,安全有效利于重症肌无力病人术后呼吸功能的恢复。

Objective: To oberserve clinical appliance of infusion propofol in minim pump in thymectomy for MG. Method: 24 adult patients, ASA grade Ⅰ～Ⅱ, thymectomy for MG, were randomly divided into two groups A and B. They were all slowly induced endotracheal intubatton. Anaesthesia maintain group A: inhalation of 2%～3% enflurance and intermittent bolus of fentanyl; group B: infusion propofol in minim pump with 6～9mg/kg/h, and intermittent bolus of fentanyl. In the operation deliver small dose tiacrium extenuatorily. Hemodynamics was recorded during the whole procedures. Results: In group B the hemodynamics was kept stable (P>0.05);in group A MAP increased markedly during intubation and incision (P<0.05).The analepsia duration was shorten in group B as compared with that in group A (P<0.05).Conclusion: Infusion propofol in minim pump can make drug consistence in blood steady , make anaesthesia calm and kilter. The patients came round rapidly and may be early pulled pipe out , so benefiting for their recovery of respiratory function.