丙泊酚靶控输注用于重症心脏瓣膜病患者全麻诱导

Target-controlled infusion of propofol for induction of general anesthesia in patients with severe valvula heart disease

目的探讨丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性和有效性。方法重症心脏瓣膜病患者47例,随机分成丙泊酚组(P组,n=24)和依托咪酯组(E组,n=23)。P组以丙泊酚靶控输注,初始血浆靶浓度1.0μg/ml,采用改良警觉/镇静(MOAA/S)评分行镇静评分,每2分钟递增靶浓度0.2μg/ml,至患者MOAA/S评分≤1分时给予芬太尼5μg/kg、维库溴铵0.1mg/kg。E组使用依托咪酯0.25～0.30mg/kg和同剂量的芬太尼、维库溴铵并行气管插管。记录入室(T1)、MOAA/S评分≤1分(T2)、诱导期收缩压最低点(T3)、插管前(T4)、插管完毕(T5)、插管后5min(T6)时的SBP、DBP、HR、CVP;记录血管活性药物的使用情况。结果与T1时比较,P组T2～T6时SBP、DBP明显下降,HR明显减慢(P<0.05或P<0.01),E组T2～T4、T6时的SBP,T2～T6时的DBP明显下降,T2～T4时HR明显减慢(P<0.05或P<0.01),T3、T4时两组CVP明显降低(P<0.05或P<0.01)。与E组比较,P组T5时的SBP,T5、T6时的DBP明显降低,T5、T6时HR明显减慢(P<0.05或P<0.01)。P组患者在T2时的血浆靶浓度平均值为1.61μg/ml。结论丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性与依托咪酯相似,并且能更好地抑制气管插管后的应激反应。

Objective To assess the safety and feasibility of the titrimetric target-controlled infusion （TCI） of propofol for induction of general anesthesia in patients with severe valvular heart disease.Methods Forty-seven patients were randomly allocated to group P （n=24） and group E （n= 23） to receive propofol by TCI or etomidate for induction of general anaesthesia. In group P, the initial target plasma concentration was set at 1.0μg/ml and increased by 0.2μg/ml every 2 minutes until the modified observer＇s assessment of alertness and sedation （MOAA/S） score≤1. Group E received an etomidate infusion of 0.25-0.30 mg/kg. Fentanyl 5μg/kg and vecuronium bromide 0.1 mg/kg were administrated before intubation in both groups. Hemodynamic indicators including SBP and DBP, HR and central venus pressure （CVP） at baseline （T1）, MOAA/S score≤1 （T2）, the lowest point of SBP （Ta）, preintubation （T4）, postintubation （Ta） and five min postintubation （T6） were recorded. Vasomotor drugs if used were also recorded. Results Compared with T1 , SBP, DBP and HR at T2-T6 in group E were decreased significantly（P〈0.05 or P〈0.01） ,SBP at T2-T6 and T6 ,DBP at T2-Ts, HR at T2-T4 in group E were decreased significantly（P〈：0.05 or P〈0. 01）. Compared with group E ,SBP at T5 ,DBP and HR at Ts and T6 in group P were decreased（P〈0. 05 or P 〈 0.01）. The average target plasma concentration at T2 in group P were 1.61 μg/ml. Conclusion Application of titrimetric TCI with propofol in induction of general anesthesia is as safe as etomidate infusion,which can even inhibited the post-intubated stress response better.