脑电双频指数指导下丙泊酚、舒芬太尼联合靶控对冠状动脉旁路移植术麻醉诱导期血流动力学影响

The effects of target-controlled of propofol and sulfentanil on the haemodynamics of patients undergoing coronary cartery bypass grafting under the direction of the bispectral index

目的:观察丙泊酚、舒芬太尼不同靶控浓度在冠状动脉旁路移植术(CABG)麻醉诱导期对脑电双频指数(BIS)、心率(HR)、平均血压(BP)变化的影响。方法:30例CABG患者,随机分为A、B、C 3组,每组10例。诱导方法依次为:A组,咪哒唑仑0.05 mg/kg,丙泊酚、舒芬太尼靶控输注(TCI)浓度分别为2.0μg/ml、0.3 ng/ml,维库溴铵0.1 mg/kg,依托咪酯0.3 mg/kg;B组,咪哒唑仑0.05 mg/kg,丙泊酚、舒芬太尼TCI浓度分别为1.5μg/ml、0.5 ng/ml,维库溴铵0.1 mg/kg,依托咪酯0.3 mg/kg;C组咪哒唑仑0.05 mg/kg,丙泊酚、舒芬太尼TCI分别为1.0μg/ml,0.8 ng/ml,维库溴铵0.1 mg/kg,依托咪酯0.3 mg/kg。观察麻醉前,诱导后1 min、5 min,插管后5 min、10 min之后患者BIS值及HR、BP变化。结果:B组与A、C组比较,既能维持BIS的麻醉深度,且麻醉后不同时间段BP、HR相对稳定,气管插管应激反射轻。结论:CABG麻醉,丙泊酚1.5μg/ml,舒芬太尼0.5 ng/ml TCI诱导,镇静镇痛满意,BIS值50～60,血流动力学相对稳定,为较好的组合诱导方法。

Objective：To observe the varity of heart rate（ HR）, mean arterial pressure（BP） and the bispectral index（BIS） of patientwith coronary artery bypass grafting （CABG） treated with different concentration of target-comtrolled infusion （TCI） of propofol and sulfentani during the induction of anaesthesia. Methods ： Thirty cases with coronary artery bypass grafting surgery were randomly divided into three groups （ 113 eases each group） , group A were induced to knocked out with 0. 135 mg/kg of midazolam, 13. 1 mg/kg of vecuronium ,0.3 mg/kg of etomidate and the concentration of TCI of 0.3 ng/ml of sulfentanil and 2 μg/ml of propofol, group B were induced to knocked out with 0.05 mg/kg of midazolam,0.1 mg/kg of vecuronium ,0.3 mg/kg of etomidate and the concentration of TCI of 0.5 ng/ml of sulfentanil and 1.5 μg/ml of propofol and group C were induced to knocked out with 0.05 mg/kg of midazolam ,0.1 mg/kg of vecuronium ,0.3 mg/kg of etomidate and the concentration of TCI of 0.8 ng/ml of sulfentanil and 1.0 μg/ml of propofol. The data of HR,BP and BIS of three groups were recorded at the time-points of pre anaesthesia（T0 ） ,one（ T1 ） and fiue minutes（T2） after induction of anesthesia and five minutes （ T3 ） and ten minutes （ T4 ） after intubation. Results ： Compared with group A and C, the blood pressure, heart rate of group B were relatively stable at different time points postinduction, the BIS kept at the moderation depth of anesthesia and the stress of intubation reflected light. Conclusions ： During coronary artery bypass grafting surgery, the 0.5 ng/ml and 1.5 μg/ml of sulfentanil and propofol in plasma can obtain good anaesthetic effects, keep stable haemodynamics and 513-60 of BIS, which is a good induction method.