吸入七氟醚和静脉应用丙泊酚于妇科腹腔镜手术麻醉诱导的比较  

Comparison of induction anesthesia with sevoflurance inhalation and intravenous propofol in gynaecologic laparoscopy operation

作　　者：周少丽[1] 张睿[1] 沈宁[1] 魏涧琦[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广州510630

出　　处：《中国新药杂志》2008年第21期1880-1883,共4页Chinese Journal of New Drugs

摘　　要：目的:研究吸入七氟醚和静脉应用丙泊酚对妇科腹腔镜手术麻醉诱导血流动力学和脑电双频指数(BIS)的影响。方法:选择择期妇科腹腔镜手术患者45例,随机分为3组,每组15例,麻醉诱导前1 min静脉注射0.5μg.kg-1的舒芬太尼后,A组吸入事先由8%七氟醚和8 L.min-1氧气流量预冲回路的6MAC浓度七氟醚,维持吸入七氟醚浓度为4MAC;B组麻醉诱导调定丙泊酚效应部位浓度为3 mg.L-1;C组静脉单次推注2 mg.kg-1的丙泊酚。3组患者入睡后推注0.6 mg.kg-1的罗库溴铵,当BIS≤60并维持5 s后行气管插管,观察3组患者血流动力学和BIS的变化,并记录患者入睡时间、BIS值到达60的时间和可行气管插管的时间以及围插管期不良反应。结果:与麻醉诱导前相比,推注舒芬太尼后1 min 3组患者血压和心率变化不明显(P>0.05),BIS值轻度下降;3组患者插管前BIS≤60并维持5 s时的血压均下降(P<0.05),单次推注丙泊酚最明显,靶控输注次之;心率下降以靶控输注最明显;3组患者气管插管后1和3 min血压及心率值较插管前升高(P<0.05),以单次推注丙泊酚组明显,插管后5 min降至插管前水平;A组和C组患者诱导入睡时间、BIS值下降至60时间和可以气管插管时间比B组短(P<0.05),3组患者围插管期无不良记忆反应。结论:吸入七氟醚麻醉诱导及靶控输注和静脉单次注射丙泊酚麻醉诱导能较好抑制插管应激反应和提供足够的麻醉深度,与吸入七氟醚诱导相比单次推注丙泊酚围诱导期血流动力学波动较大,靶控输注丙泊酚耗时较长,吸入七氟醚麻醉诱导更为平稳和快速。Objective：To compare the effects of sevoflurance inhalation and intravenous propofol on bispectral index and hemodynamic changes during the induction anesthesia in gynaecologic laparoscopy operation.Methods： In a double-blind and random study,45 patients scheduled for gynaecologic laparoscopy operation were divided into 3 groups（n=15 for each）.After intravenous 0.5μg·kg-1 sufentanil,patients were anesthetized with inhalation of sevoflurance 6 MAC concentration then maintained with 4 MAC concentration（group A）,or anesthetized with the target controlled induction concentration of propofol 3mg·L-1（group B） or with a single intraveneous dose of propofol 2mg·kg-1（group C）.After all the patients went into sleep,rocuronium bromide 0.6mg·kg-1 was iv injected.When bispecral index（BIS） decreased to 60,the trachea was intubated.The changes in hemodynamics and BIS were observed at time points before induction（T0）,1min after sufentanil injected（T1）,the BIS value to 60（T2）;and 1min（Ti1）,3min（Ti3） and 5min（Ti5） after intubation.Time going into sleep,time for the BIS to 60 and carrying intubation were also observed.Results： Compared with the values at T0,the BIS decreased slightly,and the heat rate and the blood pressure did not remarkably change at T1（P〉0.05）.At T2,the heart rate and blood pressure were significantly lower than those at T0（P〈0.05）,especially in groups B and C.The blood pressure and heart rate at Ti1 and Ti3 were markedly higher than those at T3（P〈0.05）,and returned to the levels of T0 at 5min after intubation（Ti5）.The BIS were lower than 60 during anesthesia induction,and no adverse reaction concerning memory was observed in three groups.In groups A and C,the time going into sleep,time for the BIS to 60 and carrying intubation were also shorter than those in group B（P〈0.05）.Conclusion： Induction anesthesia with sevoflurance inhalation,TCI propofol and single intraveneous propofol can induce good anesthesia,and inhibit cardiovas

关 键 词：七氟醚 丙泊酚 全身麻醉 血流动力学 脑电双频指数 

分 类 号：R971.2[医药卫生—药品] R614[医药卫生—药学]