不同剂量地佐辛预注对全麻诱导期血流动力学及脑电双频指数的影响

Influence of different dose of Dezocine on hemodynamic responses and the Bispectral index during general anesthesia induction

目的观察不同剂量地佐辛静脉预注对全麻诱导期间血流动力学和脑电双频指数（BIS）的影响。方法80例拟行气管插管全麻择期手术患者，美国麻醉医师协会（ASA）Ⅰ-Ⅱ级，随机分为4组，每组各20例。各组麻醉诱导前用药分别为：D1组：地佐辛0．05mg／kg；D2组：地佐辛0．1mg／kg；D3组：地佐辛0．2mg／kg；C组：生理盐水5mL。4组患者均给予芬太尼3tLg／kg，异丙酚2mg／kg，罗库溴铵0．6mg／kg，快速诱导后气管插管。观察给药前（T0）、麻醉诱导后气管插管前（T1）、气管插管即刻（T2）、气管插管后1min（T3）、3min（T4）、5min（T5）时脑电双频指数（BIS）、平均动脉压（MAP）、心率（HR）的变化。结果MAP、HR值比较，C组、D1组在T2-4时点明显高于T1时点（P〈O．05），D2组仅在T2、T3时升高（P〈0．05），D3组变化不明显；但相同时点比较，MAP、HR值D2、D，组低于C组（P〈0．05）。BIS值比较，与T1时比较，C组、D1组在T2、T3时明显升高（P〈0．05），D2组仅在T2时升高（P〈0．05），D3组在T4、T5时显著低于T1时（P〈0．05），D3组在T2-5时明显低于C组（P〈0．05）。结论地佐辛0．1—0．2mg／kg预注可有效抑制气管插管时的心血管应激反应，维持全麻诱导期血流动力学稳定。

Objective To observe the influence of different dose of Dezocine on bispectral index and hemodynamic responses during general anesthesia induction. Methods 80 patients with ASA physical status Ⅰ - Ⅱ scheduled for operation under gen-eral anesthesia were randomly allocated into four groups with 20 cases in each group. Medication before anesthesia induction were： group D1 with Dezocine 0.05 mg/kg, group D2 with Dezocine 0.1 mg/kg, group D3 with Dezocine 0.2 mg/kg, group C with normal saline 5 mL. Anesthesia induction was performed with combination of fentanyl 3 μg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg. The bispectral index （BIS）, mean artery pressure （MAP） and heart rate （HR） were recorded before induction （T0）, preintubation after induction （T1）, at the moment of the intubation （T2） and at 1, 3, 5 minutes after intubation （T3, T4, T5）. Re-suits MAP and HR were significantly higher at T2-4 than those at Ti in group C and group Dl （P 〈 0.05）, and only were slightly higher at T2-T3 in group D2 （P 〈 0.05）, which were not different in group D3. MAP and HR in group D2 and group D3 were lower than those in group C at the same moment （P 〈 0.05）. After induction, BIS value were decreased in four groups. Compared with T1, BIS value were significantly higher at T2 andT3 in group C and D1 （P 〈 0.05）, and only were slightly higher at T2 in group D2 （P 〈 0.05）, and were significantly lower at T4-T5 in group D3 （P 〈 0.05）. BIS value were significantly lower at T2-5 in group D3 than that in group C （P 〈 0.05）. Conclusion The dose of 0.1-0.2 mg/kg Dezocine can effectively inhibit the cardiovascular effects caused by tracheal intubation and maintain a stable hemodynamic state during general anesthesia induc-tion.