摘要
目的评价不同剂量瑞芬太尼复合靶控输注（TCI）异丙酚对心脏瓣膜置换术病人气管插管时血液动力学反应的影响。方法拟行心脏瓣膜置换术的风湿性心脏病病人30例,随机分为3组（n=10）：芬太尼组（Ⅰ组）、小剂量瑞芬太尼组（Ⅱ组）和大剂量瑞芬太尼组（Ⅲ组）。麻醉诱导：Ⅰ组静脉注射芬太尼10μg/kg,然后持续静脉输注芬太尼10μg·kg^-1·h^-1;Ⅱ组和Ⅲ组静脉注射瑞芬太尼1μg/kg,然后分别持续静脉输注瑞芬太尼0.5、1.0μg·kg^-1·min^-1。3组静脉注射芬太尼或瑞芬太尼后3 min开始TCI异丙酚,初始血浆靶浓度为1.0μg/ml,逐渐递增至2.0μg/mJ。静脉注射罗库溴铵0.6mg/ kg后气管插管。分别在麻醉诱导前（T0）、诱导期间血压最低值时（T1）、插管前即刻（T2）、插管后1min （T3）、插管后2min（T4）及插管后5min（T5）时记录心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、肺毛细血管楔压（PCWP）、心脏指数（CI）、外周血管阻力指数（SVRI）及左室每搏功指数（LVSWI）,并于上述时点测定混合静脉血氧饱和度（Sv^-O2）。记录诱导期间低血压及气管插管心血管反应的发生情况。结果3组间麻醉诱导期间低血压及气管插管心血管反应的发生率差异无统计学意义（P〉0.05）。与T0比较,各组T1,2时HR和MAP均降低,Ⅱ组T_3时HR和MAP升高,Ⅲ组T4时MAP降低,Ⅰ组和Ⅱ组T2～4时SV^-O2升高（P〈0.05）;3组间各时点CVP、PCWP、CI、LVSWI和SV^-O2差异无统计学意义（P〉0.05）。结论复合TCI异丙酚（血浆靶浓度2.0μg/ml）时,静脉注射瑞芬太尼1μg/kg负荷剂量后,持续静脉输注0.5μg·kg^-1·min^-1麻醉诱导时血压和HR下降适度,可较好地抑制心脏瓣膜置换术病人气管插管时血液动力学反应。
Objective To investigate the effects of different doses of remifentanil and target-controlled infusion （TCI） of propofol on hemodynamic response to tracheal intubation in patients scheduled for cardiac valve replacement. Methods Thirty ASA Ⅲ or Ⅳ patients （ NYHA Ⅲ or Ⅳ ） of both sexes aged 25-52 yr weighing 39-58 kg scheduled for cardiac valve replacement were enrolled in this study. The patients were premeditated with intramuscular morphine 0.2 mg/kg and scopolamine 0.3 mg. Swan-Ganz catheter was placed via right internal jugular vein. Auditory evoked potential index （AAI） was monitored during induction of anesthesia. The patients were randomly divided into 3 groups （ n = 10 each） ： group Ⅰ received a loading dose of fentanyl 10 μg/kg followed by a continuous intusion at 10 μg·kg^- 1 · h^- 1 （F） ; group Ⅱ and Ⅲ received a loading dose of remifentanil 1.0 μg/ kg followed by a continuous infusion at 0.5 （group Ⅱ , R-1 ） or 1.0 μg·kg^-1 · min^-1 （group Ⅲ , R-2）. TCI of propofol was started at 3 min after the loading dose of fentanyl or remifentanil. The initial target plasma concentration （CT ） was set at 1.0 μg/ml followed by increments of 0.2-0.3 μg/ml every 30 seconds until 2.0 μg/ ml. AAI was maintained 〈 30. When the patients lost consciousness tracheal intubation was facilitated with rocuronium 0.6 mg/kg. Hemodynamic parameters and AAI were recorded before induction （T0, baseline）, after TCI of propofol was started when BP was lowest （T1）, immediately before intubation （T2 ） and at 1, 2 and 5 min after intubation （T3,4,5）. Results There was no significant difference in the incidence of hypotension during induction of anesthesia and hemodynamic response to tracheal intubation among the 3 groups. HR and MAP were significantly decreased at T1 and T2 as compared with the baseline at To in all 3 groups. HR and MAP were significantly increased at T3 as compared with the baseline at To in group Ⅱ , MAP was significantly decreased at T
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第11期975-978,共4页
Chinese Journal of Anesthesiology
