脑电双频指数监测下丙泊酚复合瑞芬太尼靶控输注在老年高血压病人麻醉诱导期的观察研究

Observation on the clinical application of target-controlled infusion of propofol and remifentanil guided by bispectral index for anesthetic induction in elderly and hypertensive patients

目的观察脑电双频指数(BIS)监测下丙泊酚复合瑞芬太尼靶控输注(TCI)在老年高血压病人麻醉诱导期的血流动力学变化及应激反应。方法开腹行直、结肠癌根治术的老年高血压病人60例,随机分为两组:Ⅰ组在BIS监测下以血流动力学参数为指导,丙泊酚复合瑞芬太尼靶控输注麻醉诱导;Ⅱ组仅以血流动力学参数为指导恒速推注丙泊酚及瑞芬太尼诱导。记录入室静卧10 min(T0)、意识消失时(T1)、气管插管即刻(T2)及插管后1 min(T3)、3 min(T4)、5 min(T5)的HR、SBP、DBP;并测定上述时点血糖(Glu)及血浆皮质醇(Cor)浓度变化。结果 T1、T2时两组HR、SBP、DBP明显低于T0时(P<0.05);T3、T4时Ⅰ组SBP、DBP明显低于Ⅱ组,HRⅡ组明显快于Ⅰ组(P<0.05);T2时两组Cor浓度明显低于T0时(P<0.05),T3、T4时Ⅱ组Cor浓度明显高于Ⅰ组(P<0.05)。结论 BIS监测下丙泊酚复合瑞芬太尼TCI应用于开腹行直、结肠癌根治术的老年高血压病人麻醉诱导,能较好地控制麻醉深度,降低插管应激反应,维持麻醉诱导期血流动力学的平稳。

Objective To observe the hemodynamic change and stress reaction of target-controlled infusion （TCI） of propofol and remifentanil guided by bispectral index surveillance （BIS） for anesthetic induction in elderly and hypertensive patients. Methods Sixty elderly and hypertensive patients undergoing colorectal surgery were randomly allocated into two groups. In group I , propofol and remifentanil were performed in the form of TCI guided by BIS and hemodynamie parameters for anesthetic induction. In group II ,propfol and remifentanil were pumped and guided by hemodynamie parameters at constant rate. HR, SBP, DBP, BIS, blood glucose, and serum cortisol were recorded at the time of ante-induction （TO ）, loss of consciousness（T1 ） ,intubation（ T2 ） , and at 1 min （ T3 ） , 3 min （ T4 ） , and 5 min （ T5 ） after intubation. Results SBP, DBP and HR were lower at Tt ,Tz than at TO （P 〈 0.05） in two groups, and at T3 and T4, SBP, DBP and HR in group I were lower than those in group II （P 〈 0.05 ）. Cortisol concentration was lower at T2 than at TO （ P 〈 0.05 ） in two groups ; cortisol concentrations at T3, T4 were higher in group II than those in group I. Conclusion TCI of propofol and remifentanil guided by BIS in elderly and hypertensive patients undergoing coloreetal surgery can control the depth of anesthesia better, attenuate the stress reaction caused by tracheal intubation, and keep hemodynamic smooth during anesthesia induction.