OSAS患者在盲探插管异丙酚TCI麻醉中血流动力学的变化  

Study of hemodynamic changes in patients with obstructive sleep apnea syndrome during propofol target controlled infusion for blind tracheal intubation anesthesia

作　　者：姜虹[1] 朱也森[1] 

机构地区：[1]上海第二医科大学第九人民医院麻醉科,上海200011

出　　处：《上海第二医科大学学报》2004年第11期926-929,共4页Acta Universitatis Medicinalis Secondae Shanghai

基　　金：上海市青年科技启明星计划 (0 2QB1 4 0 2 0 )资助项目

摘　　要：目的观察阻塞性睡眠呼吸暂停综合征 (OSAS)患者盲探插管靶控输注 (TCI)麻醉中血流动力学的变化。方法选择 6 0例颌面外科OSAS患者 ,随机等分为 3组。所有患者均采用盲探气管插管 ,于插管前 5min静注芬太尼 4 μg/kg ,组Ⅰ、Ⅱ同时实施异丙酚TCI麻醉 ,靶血药浓度分别设定为 1.5、2 .0 μg/mL ;组Ⅲ采用清醒插管。结果实施TCI后 ,组Ⅰ的HR、MAP、SVR下降明显(P <0 .0 5 ) ,ACI稍有下降 ;组Ⅱ的HR、MAP、SVR和ACI均明显下降 (P <0 .0 5 ) ,CO、CI稍有下降 ;组Ⅲ用药后血流动力学变化不明显。插管过程中 ,与用药前比较 ,组Ⅰ的SVR稍有下降 ,组Ⅱ的SVR显著下降 (P <0 .0 5 ) ,且明显低于组Ⅲ (P <0 .0 5 ) ,两组的HR、MAP、ACI、CO、CI基本无变化 ;组Ⅲ的HR、SVR、MAP有明显升高 (P <0 .0 5 ) ,SV、CO、CI稍有下降。结论在合适的靶血药浓度下 ,异丙酚TCI麻醉有助于OSAS患者在盲探插管中血流动力学的稳定 。Objective To observe hemodynamic changes in patients with obstructive sleep apnea syndrome during propofol target controlled infusion for blind tracheal intubation anesthesia. Methods Sixty cases with OSAS of maxillofacial surgery were devided into three groups. They were intubated by a new blind tracheal intubation technique.Before intubation 5 min, the three groups were used fentanyl 4 μg/kg by intravenous infusion, group Ⅰ and group Ⅱ were administered propofol TCI 1.5,2.0 μg/mL respectively. Results In groupⅠ, HR,MAP,SVR decreased obviously(P<0.05)and ACI decreased slightly after TCI. In groupⅡ, HR,MAP,SVR,ACI decreased obviously(P< 0.05)and CO,CI decreased a little after TCI. In group Ⅲ, there were no significant hemodynamic changes after administered fentanyl. During intubation, SVR decreased slightly in groupⅠ, SVR decreased obviously in groupⅡ (P<0.05). It was siginificantly lower in groupⅡ than in group Ⅲ(P<0.05). There were no obvious changes of HR,MAP,ACI,CO,CI in groupⅠ and groupⅡ. In groupⅢ, HR,SVR,MAP increased obviously(P<0.05), SV,CO,CI decreased a little. Conclusion Propofol target controlled infusion is a good anesthesia method to make hemodynamic parameters steady and decrease cardiovascular stress in patients with obstructive sleep apnea syndrome during blind tracheal intubation if target blood concentration controlled propiately.

关 键 词：盲探插管 靶控输注 异丙酚 血流动力学 阻塞性睡眠呼吸暂停综合征 

分 类 号：R614[医药卫生—麻醉学]