异丙酚诱异对心瓣膜手术病人血流动力学的影响

Hemodynamic Effects of Propofol Induction in Patients Undergoing Cardiac Valve Operation

目的和方法：采用ＳｗａｎＧａｎｚ导管及热稀释法检测心搏量技术，观测心瓣膜手术病人异丙酚（１５ｍｇ／ｋｇ）诱导时的血流动力学（血动学）变化。结果：两组病人麻醉前血动学紊乱主要表现为右心后负荷及作功增加；给予异丙酚１５ｍｇ／ｋｇ后２ｍｉｎ，ＨＲ、ＣＩ、ＭＰＡＰ、ＭＡＰ、ＰＣＷＰ、ＬＶＷＩ、ＲＶＷＩ较麻醉前明显降低，在无气管插管操作刺激的Ａ组中可一直持续，并超过１０ｍｉｎ；Ｂ组病人麻醉后３ｍｉｎ行气管插管，插管后ＲＡＰ、ＰＣＷＰ、ＭＰＡＰ、ＭＡＰ、ＣＩ、ＳＶＲＩ和ＰＴＲＩ明显升高且超过插管前及麻醉前（Ｐ＜００１）。结论：１５ｍｇ／ｋｇ异丙酚对于心瓣膜疾患病人的心血管功能有明显抑制，但其麻醉深度尚不足以抑制气管插管所致的心血管反应，临床麻醉中应予以注意。

Objective and Methods:The hemodynamic effects of propofol (1 5mg/kg) induction were studied with Swan Ganz catheter technics in 19 patients undergoing cardiac valve operattion. Results:The hemodynamic disturbance before anesthesia was manifested by a higher afterload and work in the right ventricular system. The HR、CI、MPAP、MAP、PCWP、LVWIand RVWI were reduced significantly at 2min after 1 5mg/kg propofol compared with pre anesthesia values. The hemodynamic changes were continuous in group A, (without intubation stimulation during the measurement), for more than 10min. In group B, at 2min after propofol 1 5mg/kg and tracheal intubation, RAP、PCWP、MPAP、MAP、CI、SVRI and PTRI were increased significantly compared with the pre intubation and pre anesthesia. Conclusion:Induction with propofol 1 5mg/kg in patients with cardiac valve disease has depressive effects on circulatory system and the depth of anesthesia produced by 1 5mg/kg propofol cannot inhibit the intubation rcsponse effectively.