权重配方法研究咪达唑仑、芬太尼和丙泊酚联合诱导对血流动力学的影响

Analysis of the effects of the co-induction of midazolam,fentanyl and propofol on hemodynamics using weighted modification method

目的:采用权重配方法分析咪达唑仑(Mid)、芬太尼(Fen)和丙泊酚(Pro)联合诱导时对血流动力学的影响。方法:60例ASAⅠ~Ⅱ级择期行腹腔镜手术的病人,根据权重配方法设计,均匀分配至6个不同剂量水平不同的用药组(配伍组1~6),麻醉诱导为依次注入Mid(15s)、Fen(15s)、Pro(30s)和罗库溴铵0.6mg/kg。Pro注入后3min行气管插管。记录诱导前、Pro注入后1min、2min、插管即刻、插管后1、3、5、7min的平均动脉压、心率值。结果:以平均动脉压为评价指标,3药在组方中的重要程度为Pro>Mid>Fen,其理论优化组方为Mid0.06mg/kg,Fen0.005mg/kg,Pro1.5mg/kg;以心率为评价指标,三药在组方中的重要程度为Fen>Pro>Mid。其理论优化组方为Mid0.06mg/kg,Fen0.005mg/kg,Pro1.25mg/kg。结论:Pro和Fen在维持血流动力学稳定上起主要作用,Mid、Pro和Fen之间有协同作用,理想的诱导剂量为Mid0.06mg/kg,Fen0.005mg/kg,Pro1.25mg/kg。

Objective: To investigate the effects of the co-induction of midazolam ( Mid),fentanyl ( Fen) and propofol ( Pro) on hemodynamics using weighted modification method.Methods: Sixty patients with ASA class Ⅰ or Ⅱ scheduled by laparoscopic operation were evenly distributed to 6 different dose groups according to the weighted modification method.The anesthesia induction was performed by injecting Mid( 15 s),Fen( 15 s),Pro( 30 s) and 0.6 mg /kg of rocuronium bromide successively.Endotracheal intubation was performed after 3 min of Pro injection.The MAP and HR were recorded before induction,after 1 and 2 min of induction,at intubation,after 1,3,5 and 7 min of intubation.Results: The mean arterial pressure was used as the evaluation index,the importance of the three drugs in the formulation was Pro > Mid > Fen,and the theoretical optimization of Pro,Mid and Fen were 1.5 mg /kg, 0.06 mg /kg and 0.005 mg /kg,respectively.The HR was used as the evaluation index,the importance of the three drugs in the formulation was Fen > Pro > Mid,and the theoretical optimization of Mid,Fen and Pro were 0.06 mg /kg,0.005 mg /kg and 1.5 mg / kg,respectively.Conclusions: Pro and Fen play a major role in maintaining hemodynamic stability,Mid,Pro and Fen have synergistic effects,and the ideal induced doses of Mid,Fen and Pro are 0.06 mg /kg,0.005 mg /kg and 1.25 mg /kg,respectively.