全麻诱导时丙泊酚滴定给药与传统给药对患者血流动力学的影响

Effect of propofol titration and traditional administration on hemodyna-mic changes during general anesthesia induction

目的:比较丙泊酚全麻诱导时滴定给药和传统给药对患者血流动力学的影响,以探求更安全、合理的麻醉诱导方案。方法:60例美国麻醉医师学会(American Society of Anesthesiology,ASA)分级Ⅰ～Ⅱ级、拟气管插管全麻下行择期手术的患者,随机分成2组,每组30例。Ⅰ组为传统给药组,按丙泊酚传统量2 mg.kg-1以250 mg.min-1的速度静脉泵注;Ⅱ组为滴定给药组,丙泊酚以1 mg.kg-1.min-1的速度静脉泵注,滴定至患者镇静警觉(OAA/S)评分1分,改为1 mg.kg-1.h-1维持。2组均在泵注丙泊酚的同时,给予芬太尼4μg.kg-1以注射泵注入。传统组给丙泊酚后1 min、滴定组入睡后给予顺阿曲库铵2 mg.kg-1静推,4 min后行气管插管。记录诱导插管期间各个时点的收缩压(SBP)、舒张压(DBP)、平均血压(MBP)、心率(HR)和脉搏氧饱和度(SpO2)。记录血压下降超过30%的例数。术后第2 d询问患者对插管过程是否有记忆。结果:2组均在一次试插即完成气管插管,术后随访均对插管过程无记忆。Ⅱ组SBP和MBP在给药后1 min、3 min及DBP在给药后1 min下降幅度均较Ⅰ组小(P<0.01)。Ⅱ组血压下降超过30%的例数较Ⅰ组少(P<0.01)。结论:和传统的给药方法相比,全麻诱导时丙泊酚滴定给药既能满足气管插管所需要的麻醉深度,又能避免血流动力学的剧烈波动。

AIM： To compare the hemodynamic changes of the patients with propofol induction by titrated ad- ministration and traditional administration. METHODS： Sixty patients with American Society of Anesthesiology （ASA） Ⅰ or Ⅱ,aged 18 -60 years and scheduled for elective surgery under general anesthesia, were selected in the study and ran- domly divided into 2 groups. The patients in group Ⅰ received intravenous infusion of propofol at the dose of 2 mg/kg by a Fresenius pump at the rate of 250 mg·min -1. The patients in group Ⅱ received intravenous infusion of propofol by a Fre- senius pump at the rate of 1 mg· kg-1· min-1 until the OAA/S scale of the patients reached 1, then propofol administra- tion changed to a maintenance dose （1 mg · kg-1·h-1 ）. As propofol was administered, fentanyl （4 ·g · kg-1） was in- travenously pumped （250 μg · min -1 ） at the same time. Cis - atracrium （2 mg · kg- 1 ） was intravenously given 1 min af- ter completion of propofol in group Ⅰ, and after the patients fell asleep in group Ⅱ. Tracheal intubation was performed 4 min later. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean blood pressure （MBP）, heart rate （HR） and pulse oxygen saturation （SpO2 ） were monitored at different time points during induction period. The cases of the pa- tients whose blood pressure decreased by more than 30% were recorded. The patients were asked whether they could recall the intubation process next day after operation. RESULTS ： All patients were successfully intuhated at the first attempt and no recall of the intubation process was observed. The decreases in SBP and MBP 1 and 3 min after propofol administration and DBP 1 min after propofol administration in group Ⅱ were significantly less than those in group Ⅰ（P 〈0.01 ）. The ca- ses of blood pressure decreasing by more than 30% in group Ⅱ were also less that those in group I. CONCLUSION： Titra- tion of propofol for anesthesia induction not only provides satisfying anesthesia for intubation, but also offers more stable he- modynamics.