异丙酚Graseby3500与TCI-Ⅰ靶控输注时对患者血流动力学的影响

Haemodynamics difference of different target controlled infusion systems between Graseby3500 and TCI-Ⅰ

目的比较不同靶控输注系统Graseby3500与TCI-Ⅰ对患者血流动力学的影响。方法选择30例ASAⅠ~Ⅱ级并符合纳入标准的支撑喉镜下声带息肉切除术病人,随机均分为2组,A组：Graseby3500;B组：TCI-Ⅰ。入室后行肘静脉穿刺置管建立静脉通道,在30min内输入10ml/kg复方乳酸林格氏液生理需要量后,选用阿斯利康Propofol Injection（Diprivan）50ml行靶控输注,血浆药物浓度设为3μg/ml,靶控开始后1分钟静注咪唑安定0.08mg/kg,芬太尼5μg/kg,司可林1mg/kg诱导插管,靶控输注20分钟。记录靶控开始及靶控停止后2.5、5、7.5、10、15、20min时的心率、呼末CO2分压、无创血压、手术时间,阿托品及麻黄素的使用例数,靶控期间输液量、手术出血量及腋温。结果两组患者的手术时间、异丙酚总用量、阿托品及麻黄素使用例数、靶控期间输液量及手术出血量无统计学差异（P〉0.05）。靶控输注前两组患者心率、血压、呼末CO2分压无差异（P〉0.05）;靶控开始后2.5、5、7.5、10min时A组心率明显低于B组（P〈0.035）,血压、呼末CO2分压无差异（P〉0.05）;靶控开始后15、20min及靶控停止后2.5、5、7.5、10、15、20min心率、呼末CO2分压及无创血压无明显差异。结论国产异丙酚TCI-Ⅰ靶控输注系统较Graseby3500系统对患者靶控输注早期心率影响较小,有可能是二者实际血浆药物浓度差异造成。靶控输注前一定的容量支持对血压的稳定有着积极的作用。

Objective To compare haemodynamics variations of different target-controlled infusion（TCI） systems between Graseby3500 and TCI-Ⅰapplied in patients.Method 30 ASA Ⅰ-Ⅱ patients undergoing polyp of cord ectomy under pedestal laryngoscope were studied.30 patients were randomly allocated to two groups including A group（Graseby3500） And B group（TCI-Ⅰ）.Lactated Ringer＇s solution as consistent with 10ml/kg·hour was infused within 30 min before TCI.The propofol plasma concentration of TCI was set at 3μg/ml and infusion time last 20min.1 min after TCI,the patients were infused midazolam 0.08mg/kg,fentanyl 5μg /kg and succinylcholine 1mg/kg to facilitate tracheal incubation.If HR was lower than 55/min or NBP was lower than 60/30mmHg,atropine 0.25mg or ephedrine 6mg was infused respectively.SBP,DBP,MBP,HR,etCO2,and armpit-temperature were continuously monitored and recorded during TCI and 20 minutes after TCI.Results At the time of 2.5,5,7.5 and 10min after target-controlled infusion,HR in A group was obviously lower（than that in B groupP0.035）.No difference was found between two groups about SBP,DBP,MBP,et CO2,and armpit-temperature.Conclusion TCI-Ⅰsystem exhibited less influence on HR during early TCI than Graseby 3500 system.Certain degree of volume support may play a positive role in the stability of blood pressure prior to TCI.