丙泊酚靶控输注和七氟烷吸入麻醉诱导对老年患者血流动力学的影响  

Comparison of the effects of propofol target-controlled infusion and sevoflurane inhalation on hemodynamics during anesthesia induction in elderly patients

作　　者：黄萍[1] 周颖[1] 张洁[1] 王珊娟[1] 杭燕南[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200001

出　　处：《上海医学》2014年第6期482-486,共5页Shanghai Medical Journal

基　　金：上海交通大学医学院麻醉学重点学科(2008)

摘　　要：目的以脑电双频指数（BIS）作为麻醉镇静深度监测指标，应用BioZ．com无创血流动力学监测仪监测丙泊酚靶控输注和七氟烷吸入麻醉诱导对老年患者血流动力学的影响。方法选择在气管插管全身麻醉下行择期腹部手术的老年患者40例，年龄≥65岁，美国麻醉医师学会分级Ⅰ或Ⅱ级。患者随机分入丙泊酚组和七氟烷组，每组20例。丙泊酚组采用目标血浆浓度3μg／mL行静脉麻醉诱导，七氟烷组吸入体积分数为0．04的七氟烷和纯氧6L／min行吸入麻醉诱导。当BIS值〈70后，静脉注射罗库溴铵0．6mg／kg和芬太尼3μg／kg。待BIS值稳定于45～55且同时满足肌肉松弛药起效时间90s后，行气管插管操作。麻醉诱导全程采用BIS值监测麻醉镇静深度。在麻醉诱导前（T0，基础值）、麻醉诱导后2min（T1）、气管插管前1min（T2）、气管插管即刻（T3）、气管插管后1min（T4）、气管插管后3min（T5）各时间点，记录患者的无创心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心输出量（CO）、体循环血管阻力（SVR）、左心室做功（LCW）指标。记录在麻醉诱导时的丙泊酚总用量和气管插管时的七氟烷呼气末体积分数。结果麻醉诱导后，两组T1至T3和T5时间点的HR、MAP和SVR，两组T1至T5时间点的SBP、DBP和LCW，以及七氟烷组T1至T3和T5时间点的CO均显著低于同组T0时间点（P值均〈0．05），T3时间点降至最低，T4时间点出现回升，但均未超过基础值。两组T1和T4时间点的HR，两组T1、T2、T4、T5时间点的SBP、DBP、LCW，丙泊酚组T1和T4时间点的MAP、SVR，七氟烷组T4时间点的CO，七氟烷组T1、T2、T4、T5时间点的MAP，七氟烷组T2、T4、T5时间点的SVR均显著高于同组T3时间点（P值均〈0．05）。七氟烷组T1和T3至T5时间点的HR显著低于丙泊酚组同时间点（P值均〈0．05）。丙泊酚组在麻醉诱导时Objective To compare the effect of propofol target-controlled infusion and sevoflurane inhalation on hemodynamics monitored by BioZ. corn noninvasive hemodynamic monitoring system in elderly patients during anesthesia induction, with bispectral index （BIS） used as sedative index. Methods Forty elderly patients scheduled for abdominal operation under general anesthesia （American Society of Anesthesiologists [ASA] grade Ⅰ - Ⅱ , aged 65 years and more） were randomly divided into group propofol and group sevoflurane （n=20 each）. After an intravenous injection of midazolam （0. 02 mg/kg）, the patients in group propofol received a plasma concentration of 3 μg/mL propofol target-controlled infusion induction, and the patients in group sevoflurane inhaled 4% sevoflurane with oxygen （6 L/min）. When BIS decreased below 70, rocuronium （0.6 mg/kg） and fentanyl （3 μg/kg） were intravenously given. Tracheal intubation was performed when BIS was between 45 and 55and effective time of muscle relaxant was 90 s. BIS was used to monitor sedation. The hemodynamic parameters including noninvasive heart rate （HR）, systolic pressure （SBP）, diastolic pressure （DBP）, mean arterial pressure （MAP）, cardiac output （CO）, systemic vascular resistance （SVR） and left cardiac work （LOW） were recorded at baseline （T0）, 2 min after induction （T1）, 1 min before intubation （1-2）, intubation time （T3）, 1 min after intubation （T4） and 3 min after intubation （T5）. The consumption of propofol during induction of anesthesia and endexpiration volume fraction of sevoflurane were also recorded. Results In both groups, HR, MAP and SVR from T1 to T3 and at T5 and SBP, DBP and LCW from T1 to T5 were significantly lower than the baseline （all P〈0.05）. In group sevoflurane, CO from T1 to T3 and at T5 were also significantly lower than the baseline （all P〈0.05）. All parameters declined to the minimum at T3, rose at T4, but were below the baseline eventually. HR at T1 a

关 键 词：丙泊酚 七氟烷 无创血流动力学 靶控输注 老年人 

分 类 号：R614[医药卫生—麻醉学]