改良手控输注丙泊酚诱导对气管插管血液动力学的影响

Effects of Propofol Induction with Improved Manually-controlled Infusion on Hemodynamic Response to Tracheal Intubation

目的:观察改良手控输注丙泊酚诱导对气管插管血液动力学影响。方法:选择择期手术全麻患者40例,随机分成丙泊酚普通手控输注组(Ⅰ组)和改良手控输注组(Ⅱ组),每组20例。麻醉诱导方法:咪唑安定0.1m/kg,芬太尼4μg/kg,维库溴胺0.1mg/kg,丙泊酚2mg/kg。Ⅰ组丙泊酚单次推注完毕3m in后行气管插管术;Ⅱ组丙泊酚先推注计算总量的1/3,2m in后再推注剩余2/3剂量,推注完毕1m in后行气管插管术。记录诱导前、插管前、插管后1m in、3m in、5m in的SBP、DBP、HR值。结果:两组患者麻醉诱导后SBP、DBP、HR值均较诱导前明显下降(P<0.05),但Ⅱ组SBP、DBP值下降幅度明显小于Ⅰ组(P<0.05),HR组间比较无差异。两组患者气管插管后1m in时SBP、DBP值升高,HR加快且与诱导前有显著性差异,此后逐步下降,至5m in时SBP、DBP、HR均明显低于诱导前(P<0.05)。结论:全麻诱导时丙泊酚采用改良手控输注法其血液动力学变化较普通手控输注法更为平稳。

Objective： To study the influence of propofol induction with improved manually - controlled infusion on hemodynamic response to tracheal intubation. Method： 40 ASA Ⅰ - Ⅱ adult patients undergoing elective surgery were randomly divided into two groups （ n = 20 each ）. Anesthesia was induced with midazohun 0.2 mg/kg, fentanyl 4μg/kg, vecuronium 0. lmg/kg and propofol 2 mg/kg. as a bolus and the intubation was performed 3 minutes later in mannually - controlled infusion technique （group Ⅰ ） ;1/3 propofol was administered firsts then 2/3 propofol was administered after 2 minutes and the intubation was performed 1 minute later in improved mannually - controlled infusion technique （ group Ⅱ）. SBP, DBP and HR were recorded before anesthetic induction and intubation at 1,3 and 5 minutes after intubation. Result： The value of SBP, DBP and HR decreased significantly before intubation in two groups compared with that before anesthetic induction （ P 〈 0.05 ）, hut the value of SBP and DBP in group I were lower than that in group Ⅱ （ P 〈 0.05 ）. SBP and DBP increased significantly at Ⅰ minute after intubation but no significant differences compared with before intubation . HR increased significantly at 1 minute after intubation and there were significantly differences compared with before intubafion （ P 〈 0.05 ）. The value of SBP, DBP and HR at 5 minutes after intubation were lower than that before anesthetic induction（ P 〈0.05 ） , but no significant changes between two groups. Conclusion： The hemodynamic response to tracheal intuba- tion was more stable in improved mannually -controlled infusion technique.