异丙酚和咪唑安定对心瓣膜置换患者麻醉期血液动力学和氧代谢的影响  

Effects of propofol and midazolam for total intravenous anesthesia on hemodynamics and oxygenation state in patients undergoing cardiac valve replacement

作　　者：顾尔伟[1] 张野[1] 刘学胜[1] 司力[1] 张健[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022

出　　处：《安徽医科大学学报》2000年第5期360-363,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的　比较异丙酚和咪唑安定静脉复合麻醉对心脏瓣膜置换手术患者麻醉期血液动力学和氧代谢的影响。方法　 2 0例瓣膜置换手术患者 ,随机分为异丙酚组 (P组 ,n =10 )和咪唑安定组 (M组 ,n =10 )。分别静注异丙酚 1 5mg·kg-1和咪唑安定 0 15mg·kg-1诱导 ,并以异丙酚 2～ 6mg·kg-1·h-1或咪唑安定 0 1～ 0 2mg·kg-1·h-1维持麻醉 ,两组芬太尼用法相同。局麻下插Swan Ganz导管到肺动脉 ,监测麻醉期间血液动力学和氧代谢的变化。结果　麻醉诱导使两组病人心率 (HR)、心脏指数 (CI)和氧耗指数 (VO2 I)下降 ,平均动脉压 (MAP)分别下降 17 9% (P组 )和 12 0 % (M组 ) ,异丙酚组与咪唑安定组相比 ,心肺转流 (CPB)前、后CI、每搏指数 (SI)、左室每搏功指数 (LVSWI)相对较高。肺毛细管嵌压 (PCWP)和全身血管阻力指数 (SVRI)相对较低。停CPB后 ,异丙酚组氧摄取率 (ERO2 )较低 ,混合静脉血氧饱和度 (SvO2 )较高。结论　异丙酚静脉复合麻醉 ,在转流前、后可降低前、后负荷 ,维持较好的心脏指数并改善氧供需平衡 。Objective To compare the hemodynamic effects and oxygenation state of propofol and midazolam combined with fentanyl for total intravenous anesthesia in patients undergoing cardiac valve replacement.Methods Twenty patients were randomly divided into P (propofol,n=10)and M (midazolam, n=10)group, receiving a bolus injection of propofol 15 mg·kg -1 or midazolam 015 mg·kg -1 during induction, and a infusion of propofol 2～6 mg·kg -1·h -1 or midazolam 01～02 mg·kg -1·h -1 was used continuously during maintenance respectively. Swan-Ganz catheter was inserted into the pulmonary artery via the right internal jugular vein. Hemodynamics and oxygenation data were monitored during anesthesia.Results Induction caused a significant fall in HR,CI(P<005) and VO 2I (P<001) in both groups. MAP decreased 179%(group P)and 120%(group M) respectively. In group P, SVRI,PCWP decreased significantly (P<005 or P<001) and LVSWI,RVSWI did not change significantly, CI was higher relatively before and after CPB. After the end of CPB, ERO 2 was lower(P<005) and SvO 2 was higher (P<005) in group P than in group M. Conclusion Propofol combined with fentanyl anesthesia can effectively improve cardiac index, decrease preload and afterload and improve oxygen delivery and consumption, probably more beneficial to patients undergoing valve replacement.

关 键 词：异丙酚 血液动力学 人工心脏瓣膜 咪唑安定 

分 类 号：R654.2[医药卫生—外科学] R971.2[医药卫生—临床医学]