三种麻醉诱导方法对高血压患者血压的影响

Impacts of Three Different Induction Methods on Blood Pressure in Patients with Hypertension

目的比较高血压患者麻醉诱导过程中,分别使用异丙酚、七氟醚和异丙酚联合七氟醚进行麻醉诱导对患者血压的影响。方法选择ASAⅡ级,高血压病Ⅰ～Ⅱ级择期全麻手术患者102例,随机分为三组,异丙酚组,七氟醚、七氟醚和异丙酚联合组,每组34例。三组分别采用异丙酚、七氟醚、异丙酚联合七氟醚诱导。观察三组患者诱导前(T0),诱导后(T1),插管后(T2),收缩压(SBP)及舒张压(DBP)的变化。结果三组患者麻醉诱导后(T1)和诱导前(T0)比较,SBP和DBP均呈显著性下降,而诱导后(T1)和插管后(T2)比较,SBP和DBP均呈显著性上升(P<0.05)。异丙酚组插管后(T2)SBP和DBP与诱导前(T0)比较,差异无统计学意义(P>0.05)。七氟醚组插管后(T2)SBP和DBP与诱导前(T0)比较,差异有统计学意义(P<0.05)。而联合组插管后(T2)SBP和DBP与诱导前(T0)比较,差异有统计学意义(P<0.05)。组间比较,诱导后的血压下降,异丙酚组较七氟醚组下降幅度明显,差异有统计学意义(P<0.05)。异丙酚组与联合组相比血压下降,差异有统计学意义(P<0.05)。插管后血压上升,七氟醚组较异丙酚组血压上升,差异有统计学意义(P<0.05)。异丙酚组较联合组血压上升幅度明显,差异有统计学意义(P<0.05)。七氟醚组较联合组血压上升幅度明显,差异有统计学意义(P<0.05)。结论异丙酚、七氟醚、异丙酚联合七氟醚均可用于高血压患者的麻醉诱导,异丙酚联合七氟醚对插管后血流动力学平稳作用优于异丙酚组和七氟醚组。

Objective To compare the impacts on blood pressure in three different inductions,named propfol,sevoflure and combined propfol and sevofure methods.Methods 102 cases of ASAⅡ grade,hypertensionⅠ-Ⅱgrades and general anesthesia of selective operation were randomized into three groups,named propfol group,sevofure group and combined propfol and sevofure group,34 cases in each one.Propfor,sevofure and combined propfor and sevofure were used in induction separately in three groups.The changes in systolic pressure（SP）and dialectic pressure（DP）were observed before induction（T0）,after induction（T1）,and after intubation（T2）.Results In comparison between T1 and T0,SP and DP decreased significantly.In comparison between T1 and T2,SP and DP increased significantly（P0.05）.In propfol group,there were no differences in SP and DP between T2 and T0（P0.05）.In sevoflure group,SB and DB（T2）increased significantly as compared with SB and DB（T0）（P0.05）.In combined group,SB and DB（T2）decreased significantly as compared with SB and DB（T0）（P0.05）.In comparison among groups,the decrease amplitude of blood pressure after induction in propfol group was apparent as compared with sevoflure group with significant difference（P0.05）;and the difference between propfor group and combined group was significant statistically,too（P0.05）.After intubation,the blood pressure increase in propfol group was significant as compared with that in sevoflure group statistically（P0.05）;that in sevoflure group was significant as compared with combined group statistically（P0.05）.Conclusion Any of propfol,sevoflure and combined propfol and sevoflure is applicable in the induction of the patients with hypertension.The hymodynamic stability of the combined propfol and sevoflure induction is superior to that of either propfol or sevoflure.