异丙酚镇静对重症患者并发急性循环衰竭时容量反应性的影响  

Effect of propofol sedation on volume response in patients with severe acute circulatory failure

作　　者：林影芯[1] Lin Yingxin(Department of Intensive Medicine, Shenzhen Hospital of Peking University, Guangdong 518036, China)

机构地区：[1]北京大学深圳医院重症医学科

出　　处：《山西医药杂志》2019年第13期1527-1530,共4页Shanxi Medical Journal

基　　金：深圳市卫生计生系统科研项目(SZXJ2017024)

摘　　要：目的评价异丙酚镇静对重症患者并发急性循环衰竭时容量反应性影响。方法选取我院收治的100例并发急性循环衰竭的重症患者进行研究,根据随机数字表法分为2组,A组50例:标准镇静剂量1.5mg·kg^-1·h^-1;B组50例:小剂量镇静0.7mg·kg^-1·h^-1,给予异丙酚前、后躁动镇静评分为-2或-1分[脑电双频指数(BIS)值为60~75]实施被动抬腿试验(PLR),PLR后心排血量(CI)增加(△CI)>10%则表明容量反应阳性,△CI<10%则表示容量反应阴性,将镇静前容量反应阴性患者定义为容量反应性阴性亚组(C组),分别AC组、BC组,对比不同镇静剂量下容量反应性、血流动力学指标。结果AC组与BC组实施镇静后容量反应阳性率明显升高(P<0.05),AC组的镇静后容量反应阳性率明显高于BC组(P<0.05)。结论针对容量反应阴性的并发急性循环衰竭的重症患者,经异丙酚镇静处理可改善容量反应性,标准剂量异丙酚应用处理效果更为显著。Objective To evaluate the effect of propofol sedation on volume response in patients with severe acute circulatory failure. Methods One hundred patients with severe acute circulatory failure were selected and divided into two groups according to random number method. Group A included 50 patients with standard sedation dose of 1.5 mg·kg^-1·h^-1 and Group B 50 patients with low sedation dose of 0.7 mg·kg^-1·h^-1. Passive leg lift test (PLR) was performed for those with sedation and restlessness score of -2 or -1 (BIS value of 60-75) before and after propofol administration. CI increased after PLR. Volume response was positive for CI > 10% and negative for CI <10%. Patients with negative volume response before sedation were defined as volume response negative subgroup (group C), AC group and BC group respectively. Volume response and hemodynamic indexes were compared under different sedation doses. Results The positive rate of volume response after sedation was significantly increased in the AC group and the BC group (P<0.05). The positive rate of volume response after sedation in the AC group was significantly higher than that in the BC group (P<0.05). Conclusion In patients with severe acute circulatory failure with negative volume response, propofol administration can improve volume responsiveness. The standard dose of propofol is more effective.

关 键 词：二异丙酚 休克 容量反应阴性 

分 类 号：R459.7[医药卫生—急诊医学]