丙泊酚靶控输注联合脑电双频指数在高龄患者麻醉诱导期的应用  

The clinical application of target-controlled infusion propofol guided by the bispectral index for anesthetic induction in the elderly patients

作　　者：陈亚丽[1] 谭敬[1] 景桂霞[1] 

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,西安市710061

出　　处：《临床麻醉学杂志》2011年第9期881-884,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察丙泊酚靶控输注(TCI)联合脑电双频指数(BIS)在高龄患者麻醉诱导期的血流动力学变化及应激反应。方法高龄全麻胃癌根治手术患者45例,随机均分为三组。Ⅰ组以BIS值为控制目标;Ⅱ、Ⅲ组以临床指征为目标。Ⅰ、Ⅱ组麻醉诱导采用丙泊酚TCI,Ⅲ组以人工法输注丙泊酚,而后以恒速泵入。记录入室静卧15 min(T0),意识消失时(T1),气管插管即刻(T2),插管后1 min(T3)、3 min(T4)、5 min(T5)的HR、SBP、DBP;并测定血浆皮质醇(Cor)、血糖(Glu)及去甲肾上腺素(NE)、肾上腺素(E)的浓度变化。结果 T1、T2时三组SBP、DBP明显低于T0时(P<0.05);T3时Ⅰ、Ⅱ组SBP明显低于Ⅲ组,Ⅲ组HR明显快于Ⅰ组(P<0.05)。T2时三组Cor浓度明显低于T0时(P<0.05),T3、T4时Ⅱ、Ⅲ组Cor浓度明显高于T2时(P<0.05)。T3时三组NE、E浓度明显高于T0时(P<0.05),T5时三组NE、E浓度明显低于T3时(P<0.05)。结论在丙泊酚用于高龄患者麻醉诱导中,以BIS指导丙泊酚TCI在麻醉诱导期能够较好地维持适当的麻醉深度,降低气管插管引起的应激反应,维持麻醉诱导期血流动力学的平稳。Objective To observe the different effects on BIS guided propofol TCI and artificial method for induction of anesthesia in eider patients. Methods Forty-five elderly patients undergoing radical gastrectomy for stomach cancer were randomly allocated into three groups. In group I, BIS was definited as control target; in group Ⅱ and Ⅲ, clinical hemodynamic pramater as control target. In group I and Ⅱ, all patients were induced with propofol TCI. In group Ⅲ, pmpofol was pumped at constant rate HR, SBP, DBP and BIS were recorded in ante-induction （T0）, loss of consciousness （T1）, intubation （T2）, at 1 min （T3）, 3 min （T4） and 5 min （T5） after intuhation Blood glucose, plasma cortisol, norepinephrine epinephrine, concentration were measured at same time points. Results SBP, DBP and HR at T1 ,T2 were lower than To （P〈0.05）in three groups;at To SBP, DBP in group Ⅰ,Ⅱ were lower than that in group Ⅲ（P 〈0. 05） ; In group Ⅲ, HR were higher than that in group Ⅱ at T3. （P〈0. 05）. Cor concentration was lower at T2 than To （P〈0. 05） in three groups; in group Ⅱ, Ⅲ, cor concentration at T3 ,T4 were higher than T2 ; （P〈0. 05）;In three groups NE, E plasma concentration were higher at TO than To （P〈（0. 05）, and the concentration of NE, E at To were lower than those at T3 （P〈0. 05）. Conclusion Propofol TCI guided by the BIS in anesthesia induction can attenuate the stress reaction caused by tracheal intubation and guarantee the equability of haemodynamics.

关 键 词：丙泊酚 靶控输注 气管插管 脑电双频指数 血流动力学 应激 

分 类 号：R614[医药卫生—麻醉学]