异丙酚和乌拉地尔对胆囊手术患者气管拔管过程血流动力学的作用  

Effects of propofol versus urapidil on perioperative hemodynamics during tracheal extubation in patients with gallbladder operation

作　　者：程永冲[1] 程小斌[1] 许昌泰[2] 徐礼鲜 

机构地区：[1]解放军第三医院麻醉科,陕西宝鸡721004 [2]第四军医大学神经解剖学杂志编辑部,陕西西安710032 [3]第四军医大学口腔医院麻醉科,陕西西安710032

出　　处：《局解手术学杂志》2014年第1期53-55,共3页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金资助项目(39580683)

摘　　要：目的观察异丙酚和乌拉地尔对胆囊全麻手术患者气管拔管过程血流动力学的影响。方法选择2010年1月至2012年12月经彩色B超／CT确诊住院且行胆囊择期手术患者128例（ASAⅡ～IV级），将患者分为异丙酚组（n=64）和乌拉地尔组（n=64）。手术结束时分别缓慢静脉注射生理盐水稀释至8mL的异丙酚1．5mg／kg、乌拉地尔2．5mg／kg。用药后立即吸痰，拔除气管导管，拔管后面罩吸氧10min。双盲观察记录诱导前、用药后、吸痰时、拔管时、拔管后5min、拔管后10min的收缩压／缩张压（SBP／DSP）、心率（HR）、pH、PaO2、PaCO2和SaO2，同时记录拔管期躁动性及患者完全清醒时间。结果患者拔管后异丙酚组呛咳（4．7％帆26．6％）、躁动（3．1％w．17．2％）和舌后坠（12．5％邯．21．9％）发生率明显低于乌拉地尔组（P〈0．05）。异丙酚组和乌拉地尔组在诱导前、用药前、吸痰时、拔管时、拔管后5min和拔管后10min，SBP／DSP和心率均明显升高（P〈0．05）。2组患者清醒时间无显著性差异，手术围拔管期pH、PaO2、PaCO2、SaO2变化均无统计学差异（P〉0．05）。结论胆囊手术患者应用异丙酚预防围拔管期不良反应效果优于乌拉地尔，且不影响胆囊手术患者苏醒时间。Objective To observe effects of propofol versus urapidil on perioperative hemodynamics in patients with gallbladder opera- tion during tracheal extubation. Methods From 2010 January to 2012 December, 128 patients who were diagnosed by color B ultra/CT and then underwent gallbladder selective operation （ ASA 11 ~ IV） were selected, and they were divided into the propofol group （ n = 64） and the urapidil group （ n = 64）. At the end of operation, patients of the two groups were given intravenous injection of propofol 1.5 mg/kg and ura- pidil 2.5mg/kg which were diluted with normal saline to 8 mL respectively. Sputum suction immediately after medication, and then wiped out the endotracheal tube and gave oxygen masks for 10 rain. Record the systolic/diastolic blood pressure （SBP/DSP）, heart rate （HR）, pH, PaO2 , PaCO2 and SaO2 under double blind trial before induction, after medication, at the time of sputum suction, at the time of extuba- tion, 5 min after extubation and 10 min after extubation. At the same time, agitation during the extubation period and patients awake time were recorded. Results After extubation, cough （4. 7% vs. 26. 6% ）, agitation （3. 1% vs. 17.2% ） and glossoptosis （12.5% vs. 21.9% ） in propofol group was significantly lower than urapidil group （P 〈 0.05 ）. SBP/DSP and heart rate of propofol group and urapidil group were significantly increased （P 〈 0.05） before induction, after medication, at the time of sputum suction, at the time of extubation, 5 minafter extubation and 10 min after extubation. The recovery time of propofol group and urapidil group were of no significant differences （P 〉 0.05）. During perioperation extubation, there was no significantly difference in terms of changes of pH, PaO2 , PaCO2 and SaOz be- tween the groups （P 〉 0.05）. Conclusion Propofol is better than urapidil in preventing adverse effect of extubation for patients with gall- bladder operation, and it will not affect the recovery time of patients.

关 键 词：异丙酚 乌拉地尔 气管插管 胆囊手术 全身麻醉 

分 类 号：R614.2[医药卫生—麻醉学]