靶控输注丙泊酚在老年心血管病患者行直肠癌根治术麻醉诱导中的应用  

Application of Target Controlled Infusing Propofol in Anesthesia Induction of Radical Operation for Rectal Carcinoma of Senile Patients with Concurrent Cadiovascular Diseases

作　　者：姜万维[1] 段海霞[1] 隋成[1] 王庆辉[1] 

机构地区：[1]大连大学附属新华医院麻醉科,辽宁大连116021

出　　处：《中国肛肠病杂志》2012年第12期12-14,共3页Chinese Journal of Coloproctology

摘　　要：为观察靶控输注（TCI）丙泊酚对老年心血管病患者行直肠癌根治术麻醉诱导过程中血液动力学的影响，本研究将合并心血管病且拟行直肠癌根治术的60例老年患者随机分为静注丙泊酚组（P组）、静注依托咪酯组（E组）和TCI丙泊酚组（T组）三组，各20例。麻醉诱导：静脉泵注瑞芬太尼0．2p．g／（kg·min）；静脉注射咪达唑仑0．04mg／kg、芬太尼4μg／kg3min后，P组静脉注射丙泊酚1．0～1．5mg／kg，E组静脉注射依托眯酯0．3mg／kg，T组TCI丙泊酚（初始血浆靶浓度为1．0μg／ml，逐渐递增至2．Optg／m1）；三组患者均于意识消失时静脉注射罗库溴铵0．6mg／kg，然后接受气管插管。记录各组麻醉诱导前（T0）、麻醉诱导期间血压最低值时（T1）、气管插管前即刻（T2）及气管插管后1min（T3）、2min（T4）、5min（T5）时心率（HR）、平均动脉压（MAP）和中心静脉压（CVP），以及麻醉诱导期间低血压及气管插管2min内心血管反应的发生情况。结果显示，三组患者麻醉诱导期间低血压及气管插管心血管反应的发生率差异无统计学意义，P〉0．05。三组麻醉诱导过程中各时刻CVP均无明显变化，P〉0．05。与T0比较，各组T1、T2时HR和MAP均降低，P〈0．05；但T1和T2时刻各组间HR和MAP差异无统计学意义，P2〉0．05。与T0比较，E组T1时HR、MAP升高，T组T4时MAP降低，P〈0．05。结果表明，复合TCI丙泊酚（血浆靶浓度2．0μg／ml）麻醉诱导时患者血压和心率下降适度，可以较好地抑制老年心血管病患者行直肠癌根治术气管插管时血液动力学反应。This study was to observe the influence of target controlled infusing （TCI） Propofol for anestha- sia induction in radical operation for rectal carcinoma of senile patients with concurrent cardiovascular dis- eases on hemodynamics. The 60 patients with concurrent cardiovascular diseases to be subjected to radical operation for their rectal carcinoma were randomly divided into three gro,lps：P,E,T group;group P to be injected intravenously with Propofol,group E with Etomidate,group T to be subjected to TCI Propofol,20 cases for each group. The anesthesia induction was following as： after injection of Remifentanil （0.2/~g/kg ~ min） by venous pump, intravenously injecting Midazolam （0. 04mg/kg） and Fentanyl （4/~g/kg）, for 3 min; group P was injected with Propofol 1.0-1.5mg/kg intravenously,group E with Etomidate,while group T with TCI Propofol（primary plasma target controlled concentration was 1.0ttg/ml, then increased to 2.0 /~g/ml gradually）. When lost of consciousness the patients of 3 groups were injected with Rocuronium Bro- mide （0.6mg/kg） ,then received tracheal catheter. Then,heart rate（HR） ,mean artery pressure（MAP） ,and central venous pressure（CVP） at following time-points such as before induction（T0 ）,when the lowest val- ue of blood pressure during induction （T1）,at this time before catheter （T2）,and at lmin（T3）,2min（T4）, 5min（T~ ） following catheter, as well as the status including lower blood pressure during induction, and car- diovascular response happening when performing catheter in the three groups were recorded. As results, in lower blood pressure during induction,and happening rate of cardiovascular response there was no statisti- cal differences among three groups（ P 〉0.05）;in CVP at all time-points among three groups there also was no significant changes（ P 〉0. 05） ;compared with T0,HR and MAP at T1 and T2 in the three groups were all decreased（ P 〈40.05）,but had no statistical differences between at T1 and T2 amo

关 键 词：丙泊酚 靶控输注 麻醉诱导 直肠癌 血液动力学 

分 类 号：R699.8[医药卫生—泌尿科学]