三种麻醉方法在维持期间血流动力学的变化

Hemodynamic changes during propofol/alfentanil,sevoflurane/N 2O,and enflurane/N 2O anesthesia

目的：观察异丙酚／阿芬太尼、七氟醚／笑气以及安氟醚／笑气等三种麻醉维持期间血流动力学指标的变化。方法：４５例病人随机分为三组，每组１５例，麻醉快速诱导后经气管插入特殊的ＴＴＤ导管，麻醉维持分别采用０．１ｍｇ·ｋｇ－１·ｍｉｎ－１异丙酚和１μｇ·ｋｇ－１·ｍｉｎ－１阿芬太尼静脉泵入（Ｐ／Ａ组），１％七氟醚－６６％笑气（Ｓ／Ｎ组）或１％安氟醚－６６％笑气吸入（Ｅ／Ｎ组）。于麻醉诱导后３０分钟、手术开始后３０分钟、４５分钟、６０分钟以及术毕测定ＭＡＰ、ＣＶＰ、ＣＯ、ＣＩ和ＳＶＲ等血流动力学指标的变化。结果：在ＡＳＡⅠ～Ⅱ级的病人，临床麻醉剂量的异丙酚／阿芬太尼、七氟醚／笑气和安氟醚／笑气麻醉对血流动力学指标的影响轻微。结论：三种麻醉方法对心血管功能的影响程度相似。

Objective:To evaluate the influences of propofol/alfentanil,sevoflurane/N 2O,and enflurane/N 2O on cardiovascular system Method:Forty five patients,ASA grade Ⅰ Ⅱ,were randomly allocated into three goroups:propofol/alfentanil group (n=15,P/A),sevoflurane/N 2O group (n=15,S/N),and enflurane/N 2O group (n=15,E/N) After rapid induction all patients were intubated with a special transtracheal Doppler tube Anesthesia was maintained with continuous infusion of propofol 0 1mg/kg/min and alfentanil 1μg/kg/min (P/A group),1% end tidal concentration of sevoflurane (S/N group),or enflurane plus 66% N 2O (E/N group) Hemodynamic variables including cardiac output (CO),cardiac index (CI) and systemic vascular resistance (SVR) were continuously measured throughout anesthesia Result:The hemodynamic status of all patients was little influenced by any one of three anesthesia techniques with propofol/alfentanil,sevoflurane/N 2O,or enflurane/N 2O at clinical dosages Conclusion:In ASA grade Ⅰ Ⅱ patients propofol affects CO,CI and SVR in a similar degree to sevoflurane and enflurane