麻醉诱导期梯度效应室靶控输注丙泊酚应用对老年患者围术期血流动力学和苏醒期的影响  

Effect of target controlled infusion of propofol on perioperative hemodynamics and awakening period in elderly patients

作　　者：刘霞[1] 王文娟[1] 吴雪梅[1] 谢红[1] Liu Xia;Wang Wen-juan;Wu Xue-mei;Xie Hong(Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院,江苏省苏州市215004

出　　处：《中国组织工程研究》2018年第30期4835-4840,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:临床采用血浆或效应室靶控输注进行麻醉诱导可出现滞后及超射现象,影响患者循环系统血流动力学,出现不同的变化。目的:对比麻醉诱导期不同方式靶控输注丙泊酚对老年患者围术期血流动力学和苏醒期的影响。方法:将行腹部手术的92例老年患者随机分4组进行麻醉诱导,每组23例,Ⅰ组进行血浆靶控输注丙泊酚,Ⅱ组进行效应室靶控输注丙泊酚,Ⅲ组进行梯度血浆靶控输注丙泊酚,Ⅳ组进行梯度效应室靶控输注丙泊酚。麻醉诱导前、诱导后气管插管前、插管时、插管后即刻及插管后5 min,比较4组血流动力学指标(心排指数、平均动脉压、心率的变化);停止麻醉后,观察患者苏醒期情况(呼吸恢复时间、呼之睁眼时间、拔管时间、躁动评分、意识状态OAAS评分);麻醉诱导前及术后6,24,48 h,进行认知功能MMSE评分测评。结果与结论:(1)与麻醉诱导前比较,4组诱导后气管插管前的心排指数、平均动脉压均降低(P<0.05),心率明显升高(P<0.05);在诱导后气管插管前,Ⅳ组的心排指数、平均动脉压下降幅度明显低于其余3组(P<0.05),心率明显低于其余3组(P<0.05);在插管时、插管后即刻及插管后5 min,4组间各指标比较无差异;(2)Ⅳ组的呼吸恢复时间、呼之睁眼时间、拔管时间明显短于其余3组(P<0.05),躁动评分、OAAS评分明显低于其余3组(P<0.05);(3)与麻醉诱导前比较,4组术后MMSE评分均有降低;Ⅳ组术后6,24 h的MMSE评分均高于其余3组(P<0.05);(4)结果表明:对老年患者进行麻醉时,采用梯度效应室靶控输注丙泊酚进行诱导麻醉,不仅不影响麻醉效果,还可减轻对患者循环系统的影响,且术后麻醉恢复较快。BACKGROUND:Clinical use of plasma or target controlled infusion for anesthesia induction may lead to hysteresis and over-shoot,resulting in hemodynamic changes of the circulatory system in patients.OBJECTIVE:To compare the effects of different target controlled infusions of propofol on the perioperative hemodynamics and awakening period of the elderly patients.METHODS:Ninety-two elderly patients scheduled for abdominal surgeries were randomly divided into four groups for induction of anesthesia,23 cases in each group:group I of plasma target controlled infusion of propofol,group II of effect-compartment target controlled infusion of propofol,group III of gradient plasma target controlled infusion of propofol,and group IV of gradient effect-compartment target controlled infusion of propofol.Hemodynamic indexes(cardiac index,mean arterial pressure,heart rate changes)were compared among four groups before anesthesia induction,after anesthesia induction but before intubation,during intubation,immediately after endotracheal intubation and 5 minutes after intubation.After termination of anesthesia,the situation of patients in awakening period,including breathing recovery time,the time to open eyes on verbal command,extubation time,restlessness,and the Observer’s Assessment of Alertness/Sedation(OAAS)score,was observed before anesthesia induction and 6,24,48 hours after surgery.Mini-Mental State Examination(MMSE)scoring was used for cognitive function assessment.RESULTS AND CONCLUSION:(1)Cardiac indexes and mean arterial pressure in the four groups were significantly decreased before intubation compared with before anesthesia induction,while the heart rate increased significantly(P<0.05).Compared with the other groups,the decreased amplitude in the cardiac index and mean arterial pressure were significantly lower in the group IV(P<0.05),and the heart rate was also lower(P<0.05)before intubation.There were no significant differences among the four groups during intubation,immediately after endotracheal intubation and 5

关 键 词：靶控输注 丙泊酚 围术期 血流动力学 缓释材料 生物材料 二异丙酚 麻醉药 静脉 血流动力学 麻醉 组织工程 

分 类 号：R318[医药卫生—生物医学工程]