丙泊酚复合雷米芬太尼静脉麻醉对瓣膜置换病人血液动力学的影响

Effects of TCI propofol combined with remifentanil infusion on hemodynamics in patients with poor left ventricular function undergoing cardiac valve replacement

目的评价丙泊酚靶控输注(TCI)复合雷米芬太尼全凭静脉麻醉对风湿性心脏病瓣膜置换手术病人血液动力学的影响。方法20例风湿性心脏病行主动脉瓣和二尖瓣双瓣置换手术病人,随机分为丙泊酚TCI复合雷米芬太尼组(PR组)和咪唑安定复合芬太尼组(MF组),每组10例。采用连续心排血量(CCO)和混合静脉血氧饱和度(SVO2)监测血液动力学变化,分别在麻醉诱导前(T0)、诱导后(T1)、气管插管后2min(T2)、纵断胸骨后2min(T3)、心肺转流(CPB)前10min(T4)、停CPB10min(T5)及术毕(T6)作参数测定。重点观察诱导期血压变化及影响机理。结果PR组5例病人诱导前心脏指数(CI)<2.2L·min-1·m-2,诱导后外周血管阻力指数(SVRI)降低,CI增加,MAP下降18.8%。停转流后,PR组SVRI均较低,而CI相对较高,MAP维持满意。麻醉期间两组病人SVO2维持在70%以上,AEPI在30以下。结论丙泊酚TCI复合雷米芬太尼静注诱导期血液动力学平稳,可以安全地应用于风湿性心脏病瓣膜置换手术病人。

Objective To assess the hemodynamic stability of a total intravenous anesthesia （TIVA） using propofol target-controlled infusion（TCI） and remifentanil in patients undergoing cardiac valve replacement. Methods Twenty patients with rheumatic heart disease undergoing aortic and mitral valve replacement were randomly divided into propofol TCI and remifentanil group （PR, n= 10） and midazolam and fentanyl group （MF, n = 10）. Swan-Ganz catheter was placed for mixed venous blood Oz saturation （SvO2 ） and hemodynanic monitoring before induction. Auditory evoked potential index （AEPI） was also monitored throughout anesthesia. The hemodynamic parameters and AEPI were recorded before induction of anesthesia （T0） ,after induction （T1）, at 2 min after intubation（T2 ）, 2 min after sternotomy （T3）, 10 rain before bypass（T4 ）, 10 rain after bypass（T5 ） and poststernal closure （T6）. Results There was no significant difference between two groups. In patients with poor left ventricular function （preinduction CI〈2.2 L·min^-1·m^-2） hemodynamics were also stable during induction. In both groups Sv Oz was more than 70%, and AEPI was decreased to less than 30 during anesthesia. Conclusion Propofol TCI combined with continuous infusion of remifentanil anesthesia resulted in stable hemodynamic during induction of anesthesia,and can be used safely in patients whth poor left ventricular function undergoing cardiac valve replacement.