摘要
目的:探讨麻黄碱对全身麻醉(全麻)患者丙泊酚镇静深度的影响,为麻醉过程中合理应用麻黄碱提供参考。方法:选择美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级、年龄>18岁、拟行非神经外科手术、需要丙泊酚行全麻的患者纳入研究。靶控输注丙泊酚,待血压下降、警觉/镇静评分(OAA/S)=2、脑电双频指数(BIS)稳定持续5 min后,在20~30 s内静脉滴注麻黄碱0.15 mg/kg。记录静脉滴注麻黄碱前、后不同时段心率、脉搏血氧饱和度(SpO2)、右侧桡动脉平均动脉压(MAP)、BIS和OAA/S。结果:共8例患者纳入研究,男性3例,女性5例,平均年龄(50±2)岁,平均体重指数(25.1±3.7)kg/m2。拟行腹腔镜下胆囊切除术者5例,鼻内镜下鼻窦开放术者3例。靶控输注丙泊酚前2 min,患者心率和MAP分别为(81.1±3.0)次/min和(93.3±6.4)mm Hg(1 mmHg=0.133 kPa),给予丙泊酚(13.7±2.3)min后分别下降为(60.2±0.9)次/min和(72.3±5.6)mm Hg,差异有统计学意义(均P<0.01)。给予丙泊酚前、后SpO2分别为(98.1±1.5)%和(97.8±2.4)%,差异无统计学意义(P>0.05)。静脉滴注麻黄碱前2 min MAP为(81.2±6.01)mm Hg,静脉滴注麻黄碱后1~2和3~4 min时段MAP分别升高为(87.0±6.5)和(92.6±7.4)mm Hg,差异均有统计学意义(均P<0.05)。静脉滴注麻黄碱前2 min BIS为68.9±2.1,静脉滴注麻黄碱后5~6、7~8和9~10 min时段BIS分别升高为73.6±2.97、7.7±3.1和79.5±3.0,差异均有统计学意义(P<0.05、P<0.01、P<0.01)。静脉滴注麻黄碱前2 min OAA/S为2.0±0.0,静脉滴注麻黄碱后10 min OAA/S评分升高至3.5±0.3,差异有统计学意义(P<0.05)。BIS峰值较MAP峰值滞后2~4 min出现。结论:丙泊酚全麻过程中静脉滴注麻黄碱可减浅镇静深度,建议根据手术种类和患者情况在静脉滴注麻黄碱后2~4 min内采用有效措施维持麻醉镇静深度。
Objective:To explore the effects of ephedrine on depth of sedation with propofol in patients receiving general anesthesia in order to benefit the rational use of ephedrine.Methods: The patients,who were in ASA physical status Ⅰ to Ⅱ with age of 18 years or older,scheduled to undergo non-neurological surgery under general anesthesia with propofol,were enrolled in this study.Propofol was administered by target-controlled infusion(TCI).Ephedrine 0.15 mg/kg was administrated by IV infusion within 20-30 s after blood pressure dropped,the observer' s assessment of alertness/sedation scale(OAA/S) was 2,and bispectral index(BIS) stabilized for 5 minutes.The heart rate(HR),SpO2,mean arterial pressure(MAP) of right radial artery,BIS and OAA/S were recorded at different time points before and after starting an IV infusion of ephedrine.Results: Eight patients [3 males and 5 females with average age of(50±2) years,BMI(25.1±3.7) kg/m2] were eligible for enrollment.Of them,5 patients were scheduled to undergo laparoscopic for cholecystectomy and 3 patients to undergo endoscopic paranasal sinus surgery.The patients'HR and MAP were(81.1±3.0) beats/min and(93.3±6.4) mm Hg 2 minutes before administration of propofol by TCI,respectively,and decreased to(60.2±0.9) beats/min and(72.3±5.6) mm Hg(13.7±2.3)minutes after initiation of propofol,respectively;the differences were statistically significant(P0.01 for all comparisons).The SpO2 was(98.1±1.5)% and(97.8±2.4)% before and after administration of propofol,respectively;the difference was not significant(P0.05).The MAP was(81.2±6.0) mm Hg 2 minutes before receiving an IV infusion of ephedrine and increased to(87.0±6.5) and(92.6±7.4) mm Hg within 1-2 and 3-4 minutes after starting an IV infusion of ephedrine,respectively;the differences were statistically significant(P0.05 for all the comparisons).The BIS was(68.9±2.1) 2 minutes before receiving an IV infusion of ephedrine,and increased to(73.6±2.9),(77.7±3.1) and(79.5±3.0) within 5-6,7-8 and 9-10 minutes after starting an IV infusion of ephedrine,respectively;the differences were statistically significant(P0.05,P0.01,P0.01,respectively).The OAA/S score was(2.0±0.0) 2 minutes before receiving an IV infusion of ephedrine and increased to(3.5±0.3) 10 minutes after starting an IV infusion of ephedrine;the difference was statistically significant(P0.05).The BIS,reaching its peak level,was delayed 2-4 minutes,in comparison with MAP.Conclusion: The depth of propofol-induced sedation may decrease by an IV infusion of ephedrine during general anesthesia with propofol.Therefore,effective measures should be used according to the type of surgery and the patient' s condition for maintaining the depth of sedation and anesthesia within 2-4 minutes after starting an IV infusion of ephedrine.
出处
《药物不良反应杂志》
2011年第6期348-353,共6页
Adverse Drug Reactions Journal
关键词
丙泊酚
麻黄碱
血压
麻醉深度
脑电双频指数
警觉/镇静评分
propofol
ephedrine
blood pressure
depth of anesthesia
bispectral index
observer's assessment of alertness/sedation scale