麻黄碱对全身麻醉患者丙泊酚镇静深度的影响

Effects of ephedrine on the depth of propofol-induced sedation in patients receiving general anesthesia

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.