摘要
目的比较梯度法吸入七氟烷与靶控输注丙泊酚两种麻醉方法对心脏瓣膜置换手术患者诱导阶段的临床效果。方法 30例择期行心脏瓣膜置换手术患者按随机数字表法分成两组。七氟烷组(S组,n=15)麻醉诱导给予1%七氟烷,每间隔1 min挥发罐浓度上升1%直至3%;丙泊酚组(P组,n=15)患者采用丙泊酚分步效应室浓度靶控输注(TCI)麻醉诱导,靶目标初始血浆浓度设为0.8μg/ml,每间隔1 min靶浓度上升0.5μg/ml直至插管,所有患者同时给予芬太尼5μg/kg、罗库溴铵0.6 mg/kg。记录麻醉诱导前(T0)及诱导1 min(T1)、2 min(T2)、3 min(T3)、5 min(T4)和插管即刻(T5)、3 min(T6)、10min(T7)各个时点的收缩压(SBP)、舒张压(DBP)、心率(HR)、脑电双频指数(BIS)值,于T0、T6、T7时点记录血糖浓度。结果麻醉诱导期各个时点两组血流动力学参数及血糖指标比较差异无统计学意义(P>0.05),两组SBP在T1～T7时点均下降(P<0.05),其中在T3～T7时点下降更显著(P<0.01),DBP、HR与T0时点相比在T3～T7时点下降显著(P<0.01)。两组插管后血糖指标浓度与T0比较,差异无统计学意义(P>0.05)。结论成人风湿性心脏瓣膜置换手术麻醉诱导时应用梯度法吸入七氟烷或靶控输注丙泊酚均可以降低气管插管应激反应,较好地满足气管插管,对血流动力学有一定影响,但在临床接受范围。
Objective To compare the application effects of whole sevoflurane inhaling and target-controlled infusion of propo- fol during the induction period of anesthesia and perioperation. Methods Thirty adult patients undergoing heart valve replacement sur- gery with cardiopulmonary bypass were divided into intervention group （sevoflurane group, S group）and control group（ propofol group, P group） by computer generated random number. The S group received 1% sevoflurane during the anesthetic induction period and sevoflu- rane concentration in vaporizer increased 1% per minute until reach 3%. The P group received target-controlled infusion of propofol dur- ing anesthetic induction. The initial target plasma concentration was 0. 8 μg/ml, and the concentration increased 0. 5 μg/ml every minute until intubation. At the same time, all the patients received fentanyl 5μg/kg and rocuronium 0. 6 mg/kg. The parameters such as systolic blood pressure（ SBP）, diastolic blood pressure（ DBP）, heart rate（HR） and BIS value were recorded before anesthetic induction（ To ）, induction 1 minute （ T1 ）, induction 2 minutes （ T2 ）, induction 3 minutes （ T3 ）, induction 5 minutes （ T4 ）, intubation （ T5 ）, 3 minutes after intubation（Ts ）and 10 minutes after intubation（T7 ）. Blood glucose levels at T2 ,T3 and T7 were also measured. Results There were no statistical differences on SBP, DBP, HR and blood glucose during anesthetic induction period. However, SBP decreased significantly on TI-T7 compared to T0（P 〈 0.05 ） and more significant on T3-T7 （P 〈 0. 01 ） in both groups. DBP and HR also decreased significantly during T3-T7 compared to To （P 〈 0. 05 ）, but the blood glucose had no significant change. Conclusions The use of gradient method sevoflurane inhaling and target-controlled infusion of propofol during anesthetic induction for adult heart valve replacement surgery had a certain influence on the hemodynamics but clinically accepted,which could decrease intubation stress response.
出处
《实用医院临床杂志》
2013年第2期63-65,共3页
Practical Journal of Clinical Medicine
关键词
七氟烷
丙泊酚
瓣膜置换手术
Sevoflurane
Propofol
Heart valve replacement surgery
