硫酸镁对气管插管时心血管反应的影响  

Effect of magnesium sulfate on the cardiovascular response and the stress response to endotracheal intubation

作　　者：张芸[1,2] 王世端[3] 

机构地区：[1]青岛大学医学院 [2]青岛市海慈医院 [3]青岛大学医学院附属医院麻醉科,山东青岛266003

出　　处：《泰山医学院学报》2009年第9期681-684,共4页Journal of Taishan Medical College

摘　　要：目的以BIS为麻醉深度指标,研究不同剂量硫酸镁对气管插管心血管反应的影响。方法选择ASAⅠ-Ⅱ级择期手术病人60例,,随机分为对照组（C组）、硫酸镁小剂量组（M1组）和硫酸镁大剂量组（M2组）,每组20例。麻醉诱导中靶控输注异丙酚（初始靶浓度设为2μg.ml^-1）。M1组和M2组病人在插管前3分钟分别推注硫酸镁15mg·kg^-1、25mg·kg^-1。根据BIS值变化调节异丙酚靶浓度,使BIS值维持在45-55。在BIS降至55以下行气管插管,记录诱导前、插管前、即刻、插管后1、3、5、10分钟时间点的血流动力学相关参数的变化。结果气管插管即刻和1分钟M1组和M2组SBP,MBP变化较基础值变化不明显（P〉0.05）,M2组与C组比较差异极显著（P〈0.01）。除C组插管后1分钟HR增快明显（P〉0.05）,其余各时点各组内、各组间HR变化均无差异。C组各时点异丙酚有效靶浓度均显著高于M1组和M2组（P〈0.01）。结论气管插管前静注硫酸镁可以减轻气管插管引起的心血管反应,并且能明显降低异丙酚TCI效应室靶浓度,以25mg·kg^-1更明显。Objective： To investigate the effect of magnesium sulfate for relieving the cardiovascular response to endotracheal intubation,when the depth of anesthesia was maintained at BIS 45～55.Methods： Sixty ASAⅠ-Ⅱ patients undergone elective surgery,were randomly divided into three groups with 20 patients in each group：group C propofol,group M1 propofol＋low-dose magnesium sulfate,group M2 propofol＋high-dose magnesium sulfate.Anesthesia was induced with midazolam,fentanyl and vecuronium.The initial target effective-site concentration of propofol was set at 2.0μg·ml^-1during induction.The patients in group M1 or group M2 were given magnesium sulfate in a dose of 15 or 25mg﹒kg^-1 bolus,3 minutes before endutracheal intubation.BIS value was maintained at 45-55 by modifying target effect-site concentration of propofol.Laryngoscopy and traeheal intubation were performed when BIS was below 55.SBP,DBP,MAP,HR,SpO2,Ceand BIS were recorded before anesthetic induction,before intubation,at the moment of intubation,1,3,5,10minutes after intubation.Results： SBP,MBP of group M1 and M2 were not statistically increased at the moment and 1 minute after intubation（P〉0.05）.Index of group M2 and C were of significant difference（P〈0.01） HR was significant increased 1 minutes after intubation compared with baseline values in Group C（P〈0.05）.HR in three groups were of no statistic significance at other time（P〈0.05）.Compared with group C,the effect-site concentration of propofol was decreased at every point of group M1 and M2（P〈0.01）.Conclusion： Compared with low-dose magnesium sulfate,large-dose magnesium sulfate effectively inhibits the cardiovascular response to endotracheal intubation.When combined with propofol at the same depth of anesthesia（BIS=45～55）,the target effect-site concentration of propofol in group large-dose magnesium sulfate is greatly reduced.

关 键 词：硫酸镁 二异丙酚 脑电描记术 心血管反应 

分 类 号：R614[医药卫生—麻醉学]