七氟烷或丙泊酚复合舒芬太尼全麻诱导对心血管反应的影响  

Clinical effects of sevoflurance inhalation or propofol combined with sufentanil on cardiovascular responses for induction during general anesthesia

作　　者：张睿[1] 周少丽[1] 沈宁[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国新药与临床杂志》2009年第5期372-375,共4页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的观察七氟烷或丙泊酚复合舒芬太尼联合用于全麻诱导时血流动力学和脑电双频指数(BIS)的变化。方法下腹部手术病人30例,随机分为2组,每组各15例。麻醉诱导前1min静脉注射舒芬太尼0.5μg·kg-1后,A组吸入事先由8%七氟烷和8L·min-1氧气流量预冲回路的6最低肺泡有效浓度(MAC)七氟烷,病人入睡后推注罗库溴铵0.6mg·kg-1,维持吸入七氟烷浓度为4MAC;B组以靶控输注丙泊酚行麻醉诱导,调定效应部位靶控浓度为3mg·L-1,病人入睡后推注罗库溴铵0.6mg·kg-1。当病人BIS值≤60并维持5s后行气管插管。观察2组病人麻醉诱导前(T0),舒芬太尼应用1min时(T1),病人入睡时(T2),病人BIS值≤60并维持5s时(T3),气管插管时(Ti),气管插管后1min(Ti1)、3min(Ti3)、5min(Ti5)时血流动力学和BIS的变化,并记录病人入睡时间、BIS值到达60时间和可行气管插管时间以及不良反应。结果与T0相比,2组T1时病人血压和心率变化不明显(P>0.05),BIS值轻度下降;T2及T3时的血压和心率值均下降(P<0.05),尤以B组明显。2组病人Ti1及Ti3时血压及心率值较插管前升高(P<0.05),Ti5时降至插管前水平。A组病人诱导入睡时间、BIS值下降至60时间和可行气管插管时间均比B组短(P<0.05),2组插管期均无不良记忆反应。结论复合舒芬太尼0.5μg·kg-1下吸入七氟烷麻醉诱导可以达到良好抑制插管应激反应的效果和足够的麻醉深度,且比舒芬太尼复合靶控输注丙泊酚麻醉诱导更为平顺和快速。AIM To observe the changes of bispectral index （BIS） and hemodynamics during inhalation sevoflurance or propofol combined with sufentanil for induction during general anesthesia. METHODS Thirty patients scheduled for underbelly operations were randomly divided into two groups （A and B）, 15 for each. After intravenously sufentanil 0.5 μg·kg^-1 taken for each patient in both groups, patients in group A inhaled sevoflurance with 6 MAC concentration until falling into sleep and then inhaled sevoflurance of 4 MAC concentration and administed rocuronium bromide 0.6 mg·kg^-1. In group B, the target controlled induction concentration of propofol was 3 mg·L^-1 until the patients went into sleep and then followed by administration of rocuronium bromide 0.6 mg·kg^-1. The changes of hemodynamics and BIS were observed at the time points of before induction （T0） ; 1 rain after sufentanil injected （T1） ; at the time of asleep （T2） ; to the BIS value 60 （T3）; the time intubation （Ti）, and 1 rain （Ti1）, 3 rain （Ti3）, 5 rain （T2） after intubation. Time duration of patients going into sleep, to the BIS 60 and course of carrying intubation were also observed. RESULTS After comparing with those of T0, the BIS decreased slightly, and the heart rate and the blood pressure changes were unremarkable at T1 （P 〉 0.05） ; the heart rate and blood pressure were significantly lower at T2 and T3 than those at To （P 〈 0.05）, especially in group B. The blood pressure and heart rate at Ti1 and Ti3 raised markedly higher than those at T3 （P 〈 0.05）, and returned to the levels of To at T~. The BIS were lower than 60 during induction of anaesthesia in both groups, with no adverse reaction concerning the memory. In group A, the time duration of patients going into sleep, to the BIS 60 and for carrying intubation were also shorter than those of group B （P 〈 0.05）. CONCLUSION Combined with sufentanil 0.5μg·kg^-1l, inhalation sevoflurance can provide good induction of anaesthesia and

关 键 词：丙泊酚 舒芬太尼 麻醉 全身 七氟烷 血流动力学 脑电双频指数 

分 类 号：R971.2[医药卫生—药品]