咪达唑仑—芬太尼—异丙酚联合诱导气管插管对血流动力学的影响

EFFECT TRACHEAL INTUBATION ANESTHESIA INDUCED BY MIDAZOLAM-FENTANEST-ISOPROPYL PHENOL ON HEMODYNAMICS

目的 :探讨咪达唑仑、芬太尼、异丙酚联合诱导气管插管对血流动力学的影响。方法 :择期手术 4 0例 ,随机分为生理盐水—芬太尼—异丙酚组 (A组 ,对照组 )和咪达唑仑—芬太尼—异丙酚组 (B组 ,试验组 ) ,每组 2 0例 ,气管插管全麻诱导时A组静脉给入生理盐水 6mL(10s) ,芬太尼 2 .5 μg/kg(10s) ,维库溴胺 0 15mg/kg(5s) ,异丙酚 2mg/kg(10mg/ 5s) ;B组先静注咪达唑仑 0 .15mg/kg(10s) ,然后芬太尼 ,维库溴胺 ,异丙酚行联合诱导 ,其剂量、时限与A组相同 ,观察记录两组诱导后 (6 0s) ,插管即刻及插管后 1min ,3min ,5min ,10min的HR、SBP、DBP、MAP变化。结果 :诱导结束后 6 0s,两组SBP、DBP、MAP较诱导前有显著性降低 (P <0 0 5或P <0 0 1) ,组间比较无显著性差异 ;A组诱导结束后 6 0s,HR较诱导前有显著性降低 (P <0 0 5 ) ,插管即刻、插管后 1min、3min、5minHR、SBP、DBP、MAP回升接近诱导前水平 (P >0 0 5 ) ;10minA组心率、血压继续上升比插管前水平略高 ,而B组心率、血压仍继续下降 ,但在正常范围内两组间比较P <0 0 5或P <0 0 1。结论 :咪达唑仑 -芬太尼 -异丙酚组联合诱导能取得较长时间的稳定的血流动力学指标 ,在消除心血管副反应方面较生理盐水 -异丙酚 -芬太尼组为佳。

Objective:To determine the effect of tracheal intubation anesthesia by combined induction of midazolam, fentanest and isopropyl phenol on Hemodynamics.Method:40 patients for surgical procedure were randomly distributed to two groups (20 for each): Group A: saline-fentanest- Isopropyl phenol and Group B: midazolam-fentanest-isopropyl phenol.Patients in Group A were given saline 6ml(10s), fentanest 2.5ug/Kg (10s), norcuron 0.15mg/Kg (5s) and isopropyl phenol 2 mg/Kg (10mg/5s). Patients in Group B were given midazolam 0.15mg/Kg (10s) first, then followed by fentanest, norcuron and isopropyl phenol for combined induction, which dosage and time were the same as Group A. HR, SBP, DBP and MAP were evaluated 60s after induction, on intubattion and 1st, 3rd and 5th minutes after intubation. Results:SBP, DBP and MAP in both groups had markedly decreased (P<0.05 or <0.01) 60s after intubation,but no significant difference between the two groups. HR had significantly decreased (P<0.05) in Group A 60s after intubation. HR, SBP, DBP and MAP on intubation and after intubation came back to the level of pre-intubation (P>0.05). HR and BP of 10 min in Group A continue to go up and were a little higher than pre-intubation level. In Group B, HR and BP continued to go down, but P<0.05 or P<0.01 if compared in the normal range between the two groups.Conclusion:Long-term hemodynamics indexes can be obtained by midazolam-fentanest-isopropyl phenol combined induction, which plays better role than saline-fentanest- Isopropyl phenol in eliminating cardiovascular side effect.