丙泊酚靶控输注麻醉在瓣膜置换术中的应用

The application of TCI propofol anesthesia in the surgery of the valvular replacement

目的:比较丙泊酚靶控输注(TCI)静脉麻醉和异氟醚静吸复合全麻在瓣膜置换术中的临床效果。方法:24名患者随机分成两组。丙泊酚组(n=12)气管插管后经右颈内静脉泵入丙泊酚,靶浓度2μg/ml,体外循环(CPB)期间0.8μg/ml,CPE后1μg/ml;异氟醚组(n=12)采用大剂量芬太尼复合吸入异氟醚全麻。以收缩压(SBP)≤80％基础值为反馈指标。监测SBP、心率(HR)、中心静脉压(CVP)等指标,比较术后恢复情况。结果:两组围术期血流动力学稳定,丙泊酚组清醒快,气管导管拔除早,在抑制心肌应激方面优于异氟醚组。结论:在瓣膜置换术中应用靶控输注丙泊酚辅以喉麻和硫酸镁,可大幅减少芬太尼用量,术后恢复快,该方法值得临床推广应用。

Objective:To study the benefit of propofol with target - controlled infusion (TCI) for the surgery of the valvular replacement in comparison of isoflurane inhaled anesthesia in combination with intravenous anesthesia.Methods:Twenty - four patients were randomly divided into two groups. The propofol group(n = 12) received target controlled intravenous propofol through the internal carotid vein after intubation, and the target concentration was 2μg/ml, during CPB the target concentration was 0.8μg/ml, and after CPB it was 1μg/ml. The isoflurane group (n = 12) received large - dose fentanyl combined with isoflurane inhaled anesthesia. The index of feedback was SBP≤80% of the baseline. SBP,HR,CVP were monitored and the post-operative recovery between the two groups was compared.Results: The peri-operative hemodynamics of the two groups remained steady. The patients of the propofol group regained consciousness soon after the surgery, and extubation time was earlier. The propofol group excelled the isoflurane group in inhibition of the myocardial stress. Conclusion: The application with target - controlled infusion propofol supplemented with laryngeal anesthesia and magnesium sulfate in the surgery of the valvular replacement may reduce the dose of fentanyl in a large - degree, and the patients recover rapidly. The method is worth being extended widespread.