咪达唑仑、异丙酚、芬太尼联合诱导气管插管对血流动力学的影响

Midazolam,Propofol,Fentanyl induced by tracheal intubation on hemodynamics

目的:探讨咪达唑仑-异丙酚-芬太尼-罗库溴铵联合诱导气管插管对血流动力学的影响。方法:择期行甲状腺手术患者40例,随机分为2组:咪达唑仑-异丙酚-芬太尼-罗库溴铵组(A组)和生理盐水-异丙酚-芬太尼-罗库溴铵组(B组),每组20例,全麻诱导时A组按顺序静脉注射咪达唑仑0.06～0.08 mg/kg(10 s),3 min后静脉注射异丙酚2 mg/kg(10 mg/5 s)、芬太尼2.5～4.0μg/kg(10 s)、罗库溴铵0.6～1.0 mg/kg(5 s),B组先静注生理盐水3 ml,3 min后按相同方法经静脉注射异丙酚-芬太尼-罗库溴铵行联合诱导。观察记录2组诱导前、诱导、插管、切开皮肤的HR、SBP、DBP、MAP变化,异丙酚用量及不良反应。结果:2组患者HR在各观察点比较差异无统计学意义(P>0.05)。在诱导即刻A组SBP、DBP、MAP均高于B组(P<0.05);在插管和切开皮肤即刻A组SBP、DBP、MAP均低于B组(P<0.05)。组内比较显示2组HR在诱导即刻较诱导前均明显升高(P<0.05),随后A组HR渐降(P<0.05),而B组HR变化较小(P>0.05);A组SBP、DBP、MAP在组内比较显示差异无统计学意义(P>0.05);B组SBP、DBP、MAP在诱导与诱导前、插管与诱导即刻比较差异均有统计学意义(P<0.05)。2组均无术后苏醒延迟发生,在麻醉维持期间异丙酚用量比较差异无统计学意义(P>0.05)。结论:咪达唑仑-异丙酚-芬太尼-罗库溴铵组联合诱导血流动力学指标较平稳,抑制心血管副反应较生理盐水-异丙酚-芬太尼-罗库溴铵组为佳。

Objective： To investigate the midazolam propofol fentanyl rocuronium induced by tracheal intubation on hemodynamics. Methods： line 40 cases of thyroid surgery patients were randomly divided into 2 groups： midazolam-propofol-fentanyl-rocuronium group （group A） and normal saline-propofol-fentanylrocuronium group （group B）, 20 cases of each group, anesthesia induction, when group A sequential in travenous midazolam 0.06-0.08 mg/kg （10 s）, 3 rain after the intravenous injection of propofol 2 mg/kg （10 mg/5 s）, fentanyl 2.5-4.0 μg/kg （10 s）, rocuronium 0.6-1.0 mg/kg （5 s）, Group B first intravenous injection of normal saline 3 ml, 3 min later by the same method after the intravenous injection of propofol-fentanyl-rocuronium induced combined. Two groups were observed before induction, induction, intubation, skin incision the HR, SBP, DBP, MAP changes, propofol dosage and side effects. Results： The 2 groups of patients with HR at all observation points was no significant difference （P〉0.05）. Group A in the immediate induction of SBP, DBP, MAP were higher than those in group B （P〈0.05） ; in imme diate intubation and skin incision group A of SBP, DBP, MAP were lower than group B （P〈0. 05）. Group comparison showed that A, B 2 groups in the induction of HR immediately before induction were significantly more elevated （P 〈0.05）, then group A HR gradually decreased （P 〉0.05）, while the group B with smaller HR changes （P〉0.05）; SBP, DBP, MAP in group A showed no significant difference with contsol （P 〉0.05）. In group B SBP, DBP, MAP and induced in the induction before intubation compared with immediate-induced differences were statistically significant （P 〈0.05）. Group 2 did not occur after delayed recovery in the amount of anesthesia compared with propofol during maintenance of the difference was not significant （P 〉0.05）. Conclusion： Midazolam-propofol-fentanyl-rocuronium group hemodynamic parameters induced by a more stable and inhibit the cardiovascular side effects than the normal saline-propofol-fentanyl-rocuronium group.