不同顺序TCI丙泊酚和瑞芬太尼对高血压患者诱导期低血压的影响  

Effects of propofol and remifentanil in different TCI sequences on hypotension during induction of general anesthesia in hypertensive patients

作　　者：芦秀云 刘海瑞[1] 邢丽吉 朱江[1] Lu Xiuyun;Liu Hairui;Xing Liji;Zhu Jiang(Department of Anesthesiology,The Second Affiliated Hospital of Soochow University Suzhou 215504,China;Department of Anesthesiology,Changshu First People′s Hospital,Soochow University Suzhou 215500,China)

机构地区：[1]苏州大学附属第二医院麻醉科,苏州215004 [2]苏州大学附属常熟市第一人民医院麻醉科,苏州215500

出　　处：《中华麻醉学杂志》2023年第6期705-708,共4页Chinese Journal of Anesthesiology

基　　金：苏州市民生科技关键技术应用研究(SS202055);苏州市科技发展计划项目(SKY2021042)。

摘　　要：目的评价不同顺序TCI丙泊酚和瑞芬太尼对高血压患者诱导期低血压的影响。方法择期气管插管全身麻醉高血压患者132例,性别不限,年龄50~75岁,ASA分级Ⅱ或Ⅲ级,BMI 18~30 kg/m^(2)。采用随机数字表法分为3组(n=44):C组同时TCI丙泊酚(效应室靶浓度5μg/ml)和瑞芬太尼(效应室靶浓度5 ng/ml),PR组先TCI丙泊酚,后TCI瑞芬太尼,RP组先TCI瑞芬太尼,后TCI丙泊酚。于诱导后10 min内观察低血压发生情况,记录丙泊酚和瑞芬太尼用量、麻黄碱用量、意识消失时间、气管插管时间及围术期不良反应发生情况。结果与C组比较,RP组诱导期低血压发生率降低,丙泊酚用量和麻黄碱用量减少,意识消失时间和气管插管时间延长,意识消失时BIS值升高,PR组麻黄碱用量减少,意识消失时间和气管插管时间延长(P<0.05);与PR组比较,RP组麻黄碱用量减少,意识消失时间延长(P<0.05)。3组患者诱导期气管插管反应、注射痛、呛咳、抑制比、术后谵妄、术后恶心呕吐和术中知晓发生率比较差异无统计学意义(P>0.05)。结论先TCI瑞芬太尼,后TCI丙泊酚可降低高血压患者诱导期低血压的发生。Objective To evaluate the effect of propofol and remifentanil in different target-controlled infusion(TCI)sequences on hypotension during induction of general anesthesia in hypertensive patients.Methods A total of 132 patients with hypertension of both sexes,aged 50-75 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,with body mass index of 18-30 kg/m^(2),scheduled for elective tracheal intubation under general anesthesia,were divided into 3 groups(n=44 each)using a random number table method:group C,PR group and RP group.In group C,propofol(target effect-site concentration 5μg/ml)and remifentanil(target effect-site concentration 5 ng/ml)were simultaneously given by TCI.Propofol was given by TCI followed by TCI of remifentanil in PR group.Remifentanil was given by TCI followed by TCI of propofol in RP group.The development of hypotension was observed within 10 min after induction of general anesthesia,and the consumption of propofol,remifentanil and ephedrine,time of loss of consciousness,time of tracheal intubation and adverse reactions during the perioperative period were recorded.Results Compared with group C,the incidence of hypotension during induction was significantly decreased,the consumption of propofol and ephedrine was decreased,and the BIS value was increased when consciousness disappeared,the time of loss of consciousness and time of tracheal intubation were prolonged,the BIS value was increased at loss of consciousness in PR group,and the consumption of ephedrine was significantly decreased,and the time of loss of consciousness and time of tracheal intubation were prolonged in RP group(P<0.05).Compared with PR group,the consumption of ephedrine was significantly decreased,and the time of loss of consciousness was prolonged in RP group(P<0.05).There was no significant difference in the incidence of responses to tracheal intubation,injection pain,bucking,inhibition ratio,postoperative delirium,postoperative nausea and vomiting,and intraoperative awareness during indu

关 键 词：药物释放系统 二异丙酚 瑞芬太尼 高血压 低血压 

分 类 号：R614[医药卫生—麻醉学]