丙泊酚靶控输注用于重症心脏瓣膜病患者全麻诱导

Propofol target controlled infusion for severe valvular heart disease induction of anesthesia

目的 探讨丙泊酚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 选取2013年3月至2015年3月期间我院收治的54例重症心脏瓣膜病患者作为本次试验的研究对象,将其进行数字编号,根据单双号法分为丙泊酚组（n=27）和依托咪酯组（n=27）.丙泊酚组患者用丙泊酚靶控输注,开始用1.0 μg/ml的血浆靶浓度进行输注;依托咪酯组患者用0.3 mg/kg依托咪酯靶控输注.设置6个时间点N1～N6,分别为进入手术室（N1）、镇静评分不超过1分（N2）、收缩压最低点（N3）、插管前（N4）、插管刚结束（N5）及插管结束后5 min（N6）,比较两组患者的麻醉情况.结果 与N1时比较,丙泊酚组在N2～N6时收缩压和舒张压明显下降,心率明显减慢;依托咪酯组患者在N2～N4、N6时收缩压明显下降,在N2～N6时,舒张压明显下降,在N2～N4时心率明显下降,在N3、N4时,中心静脉压明显下降.两组比较,在N5时收缩压和N5、N6时的舒张压及心率明显下降（P＜0.05）,两组患者的中心静脉压比较未见统计学差异（P＞0.05）.结论 丙泊酚靶控输注用于重症心脏瓣膜病患者的全麻诱导,对患者的血液、心率等影响较小,安全、有效,可以推广应用.

Objective To analyze the safety and efficacy of anesthesia propofol target controlled infusion for severe valvular heart disease. Methods 54 cases of severe valvular heart disease were selected from March 2013 to March 2015 period in our hospital for the study of this trial and then they were numbered and divided into propofol group（n=27） and etomidate group（n=27） according to odd and even numbers. Patients with propofol tar- get controlled infusion of propofol were infused starting with target plasma concentration of 1.0 μg/ml, etomidate group of patients were starting with 0.3 mg/kg etomidate target controlled infusion anesthesia, and the two groups were compared. The anesthesia time was set with N1-N6, they were the operating room （N1）, sedation score less than 1 minute（N2）, systolic blood pressure low（N3 ）, intubation（N4 interchange ） before and after intubation（N5 ） and 5 min after intubation （N6） respectively. Results Compared with the N1, the systolic and diastolic blood pressure and heart rate were significantly lower in N2-N6 in Propofol group etomidate patients in N2-N4, N6 sys- tolic blood pressure decreased, when N2-N6, diastolic blood pressure decreased significantly, in the N2-N4 heart rate decreased significantly in N3, N4, the central venous pressure decreased significantly between the two groups in systolic blood pressure N5 and NS, N6 when the diastolic blood pressure and heart rate decreased significantly （P〈0.05）, central venous pressure between the two groups of patients was not statistically significant （P〉0.05）. Conclusion Application of propofol target controlled infusion anesthesia for less severe valvular heart disease in- duced in the blood, heart rate and other effects on the patient, safe, effective and can be widely applied.