无阿片药麻醉诱导对气管插管患者血流动力学的影响  

Effect of opioid-free anesthesia induction on hemodynamics of patients with endotracheal intubation

作　　者：郭其发 杨成亮 王艺丹 沈通桃[1] GUO Qifa;YANG Chengliang;WANG Yidan;SHEN Tongtao(Department of Anesthesiology,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu,225000)

机构地区：[1]扬州大学附属医院麻醉科,江苏扬州225000

出　　处：《实用临床医药杂志》2022年第22期56-59,共4页Journal of Clinical Medicine in Practice

摘　　要：目的观察无阿片药麻醉(OFA)诱导对气管插管患者血流动力学的影响。方法选取择期普外科手术行全身麻醉气管插管的患者60例,随机分为观察组和对照组,每组30例。观察组先静脉泵注右美托咪定0.5μg/kg负荷量5 min,而后依次静脉注射丙泊酚2.0 mg/kg、利多卡因1.5 mg/kg、琥珀胆碱2.0 mg/kg行麻醉诱导。对照组依次静脉注射咪达唑仑0.02 mg/kg、丙泊酚2.0 mg/kg、舒芬太尼0.3μg/kg、琥珀胆碱2.0mg/kg行麻醉诱导。2组均在注射琥珀胆碱1 min后行气管插管,并在30 s内完成插管。比较2组入室时(T_(0))、麻醉诱导后(T_(1))、插管即刻(T_(2))、插管后1 min(T_(3))、插管后3 min(T_(4))、插管后5 min(T_(5))的血压[舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)]、心率(HR)及心率与收缩压的乘积(RPP)。结果与T_(0)比较,对照组患者T_(1)、T_(5)的SBP、DBP、MAP均下降,差异有统计学意义(P<0.05);与T_(0)比较,观察组患者T_(1)、T_(4)、T_(5)的HR下降,对照组患者T_(4)、T_(5)的HR下降,差异均有统计学意义(P<0.05);与T_(0)比较,2组患者T_(1)、T_(4)、T_(5)的RPP均下降,差异有统计学意义(P<0.05)。观察组患者T_(1)、T_(4)、T_(5)的SBP、DBP、MAP以及T_(5)的RPP高于对照组,T_(1)的HR低于对照组,差异均有统计学意义(P<0.05)。结论右美托咪定和利多卡因复合丙泊酚的OFA诱导对气管插管引起的心血管反应有一定的抑制作用,血流动力学变化相对稳定。Objective To observe the effect of opioid-free anesthesia(OFA)induction on hemodynamics of patients with endotracheal intubation.Methods A total of 60 patients with general anesthesia and endotracheal intubation in elective general surgery were randomly divided into observation group and control group,with 30 cases in each group.In the observation group,a dose of 0.5μg/kg dexmedetomidine was firstly injected intravenously for 5 min,followed by 2.0 mg/kg propofol,1.5 mg/kg lidocaine and 2.0 mg/kg succinylcholine intravenously for anesthesia induction.In the control group,0.02 mg/kg midazolam,2.0 mg/kg propofol,0.3μg/kg sufentanil and 2.0 mg/kg succinylcholine were successively injected intravenously for anesthesia induction.In both groups,endotracheal intubation was performed at 1 min after succinylcholine injection,and the intubation was completed within 30 seconds.The blood pressure[diastolic pressure(DBP),systolic pressure(SBP),mean arterial pressure(MAP)],heart rate(HR)and rate-pressure product(RPP)were compared between the two groups at the time points of hospital admission(T_(0)),after anesthesia induction(T_(1)),immediately after intubation(T_(2)),1 min after intubation(T_(3)),3 min after intubation(T_(4)),and 5 min after intubation(T_(5)).Results Compared with indexes at T_(0),the SBP,DBP and MAP at T_(1) and T_(5) in the control group decreased significantly(P<0.05);compared with index at T_(0),the HR at T_(1),T_(4) and T_(5) in the observation group and at T_(4) and T_(5) in the control group decreased significantly(P<0.05);compared with index at T_(0),the RPP at T_(1),T_(4) and T_(5) in both groups decreased significantly(P<0.05).In the observation,the SBP,DBP and MAP at T_(1),T_(4) and T_(5) as well as the RPP at T_(5) were significantly higher than those in the control group,while the HR at T_(1) was significantly lower than that in the control group(P<0.05).Conclusion OFA induction of dexmedetomidine and lidocaine combined with propofol has a certain inhibitory effect on cardiovascular response ind

关 键 词：无阿片药麻醉 右美托咪定 利多卡因 气管插管 血压 心率 

分 类 号：R816.2[医药卫生—放射医学] R614[医药卫生—临床医学]