异丙酚和异氟醚麻醉对硝普钠控制性降压的影响

A clinical study on effects of propofol or isoflurane anesthesia on sodium nitroprusside-induced hypotension

目的 评价异丙酚麻醉对硝普钠控制性降压的影响。方法 16例显微神经外科手术患者随机分成两组 ,待硬脑膜打开后 ,Ⅰ组 (n =8)以 10 0 μg·kg-1·min-1异丙酚静滴维持麻醉 ;Ⅱ组(n =8)以吸入 1 3MAC异氟醚维持麻醉。以 0 0 1%硝普钠溶液使MAP降低 40 %。结果 Ⅰ组血压易于下降和维持 ,停止降压后Ⅰ组MAP显著低于Ⅱ组 (P <0 0 5 ) ;Ⅰ组硝普钠平均剂量显著低于Ⅱ组 (P <0 0 0 1) ,硝普钠总量较Ⅱ组减少 5 3% ;两组各时点HR ,血浆去甲肾上腺素浓度及尿量无显著性差异 ;维持降压期间Ⅰ组血浆肾上腺素浓度 (PE)显著低于Ⅱ组 (P <0 0 5 )。结论 异丙酚维持麻醉可增强硝普钠控制性降压效果 ,减少并发症发生。

Objective To investigate the effect of propofol anesthesia on hemodynamic changes and dose requirement of sodium nitroprusside (SNP) during SNP-induced hypotension.Methods Sixteen patients undergoing elective microneurosurgery were randomly assigned to one of two groups: propofol group and isoflurane group. In propofol group (n=8) anesthesia was maintained with propofol (infusion rate 100μg·kg -1·min -1 ) after dural opening, whereas in isoflurane group (n=8) anesthesia was maintained with 1.3 MAC isoflurane.After 20 min the MAP of both groups was reduced by 40% with continuous infusion of 0.01% SNP solution.Results Blood pressure was more easily reduced and maintained in propofol group, and was lower in propofol group than that in isoflurane group following SNP withdrawl (P<0.05). The total dose of SNP in propofol group was 53% less than that in isoflurane group. There was no significant difference in HR,plasma norepinephrine concentration and perioperative urine volume between both groups. The plasma epinephrine concentration in propofol group during hypotension was lower than that in isoflurane group.Conclusions Propofol anesthesia potentiates the hypotensive effect of SNP and reduces the dose requirement of SNP and the incidence of complications. The mechanism of potentiation is probably through the vasodilating and sympatholytic effects of propofol.