不同异丙酚诱导麻醉对颅内假性动脉瘤介入治疗气管插管期心血管反应的影响

Effects of anesthesia induction with different methods of infusion of propofol on cardiovascular response in patients with pseudoaneurysms during tracheal intubation

目的观察异丙酚不同输注法行麻醉诱导对颅内假性动脉瘤介入治疗气管插管期心血管反应的影响。方法选择2010年6月至2018年5月血管内介入治疗的颅内假性动脉瘤60例,根据麻醉诱导方法分为三组:单次静脉推注组(A组)、血浆靶控组(B组)和效应室靶控组(C组),每组20例。麻醉诱导方法:A组采用异丙酚2 mg/kg单次静脉推注;B组设定异丙酚血浆靶浓度为4μg/ml;C组设定异丙酚效应室靶浓度4μg/ml。三组均同时采用瑞芬太尼4 ng/ml血浆靶浓度靶控输注诱导,待意识消失后静注罗库溴铵0.6 mg/kg,脑电双频谱指数在40～60并维持5s时行气管插管。记录进入手术室(T0)、喉镜暴露声门(T1)、气管导管过声门(T2)、气管导管进入气管后1 min(T3)、2 min(T4)、3 min(T5)平均动脉压(MAP)、心率(HR);并记录气管插管期不良反应及纠正次数。结果与T0比较,三组T1～T3 MAP均明显降低(P<0.05),三组T1～T5 HR均明显减慢(P<0.05);与B组比较,组低血压、心动过缓等发生率和纠正次数明显少于A0.05),而且B组心动过缓发生率和纠正次数少于C组(P<0.05)。C组纠正次数明显少于A组(P<0.05)。结论 4μg/ml异丙酚血浆药物浓度作为目标靶控输注浓度更适合颅内假性动脉瘤介入治疗的麻醉诱导,低血压和心动过缓不良反应等发生率更低。

Objective To observe the effect of anesthesia induction with different methods of infusion of propofol on cardiovascular response during endotracheal intubation during interventional therapy in patients with intracranial pseudoaneurysms. Methods Sixty patients with intracranial pseudoaneurysm undergoing interventional therapy were divided into three groups of 20 patients each,i.e.in group A (single intravenous injection of propofol),group B (target-controlled plasma concentration of propofol: 4 μg/ ml) and group C (target-controlled effect site concertration: 4 μg/ml).All three groups anesthesia were induced by target-controlled infusion of remifentanil (target-controlled plasma concentration was 4 ng/ml) in all the groups.Rocuronium 0.6 mg/kg was injected intravenously after the patient's consciousness disappeared.Tracheal intubation was performed when the bispectral index kept between 40 and 60 for 5 seconds.The mean arterial pressure (MAP) and heart rate (HR) were recorded at the time of entering the operating room (T0),immediately after exposure of the glottis with laryngoscope (T1),immediately after tracheal tube passing through the glottis (T2) and 1 minute (T3),2 minutes (T4) and 3 minutes (T5) after tracheal tube entering the trachea the incidence and correction times of adverse reactions during tracheal intubation were recorded.Results MAP significantly decreased at T1,T2 and T3,HR slowed significantly at T1,T2,T3,T4 and T5 in all the groups (P<0.05) compared with those at T0.MAP was significantly lower and HR was significantly slower in groups A and C than those in group B at T1 (P<0.05).The incidences of hypotension and bradycardia and the number of their correction in group B were significantly lower than those in group A (P<0.05) and the number of correction in group C was significantly lower than that in group A (P<0.05).The incidence and number of correction of bradycardia in group B were significantly lower than those in group C (P<0.05).Conclusions The plasma concentration of 4 μg/ml propofol as the target-controlled infusion concentration is more suitable for anesthesia induction in patients with intracranial pseudoaneurysms undergoing interventional therapy,and the incidence of the adverse reactions including hypotension and bradycardia is significantly lower.