摘要
目的探讨不同剂量肾上腺素连续静脉泵注对全麻纤维支气管镜检查患者血流动力学的影响。方法选择择期行纤维支气管镜检查患者80例,ASAⅠ~Ⅱ级,均采用脑电双频指数(BIS)监测下的丙泊酚复合瑞芬太尼持续静脉输注全身麻醉,随机分为4组(n=20)。C组(对照组):麻醉诱导开始即刻静脉泵注生理盐水;E1、E2、E3组:分别于麻醉诱导开始即刻静脉泵注肾上腺素0.015μg/(kg·min)、0.02μg/(kg·min)、0.025μg/(kg·min),于退出纤维支气管镜即刻停止泵注丙泊酚、瑞芬太尼及肾上腺素。记录麻醉诱导前(T0)、麻醉诱导后1 min(T1)、麻醉诱导后2 min(T2)、置入喉罩(T3)、纤维支气管镜至声门(T4)、纤维支气管镜至隆突(T5)、术毕(T6)和清醒(T7)时患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、心排血量(CO);记录麻醉时间、镜检持续时间及苏醒时间。检测麻醉诱导前及清醒时患者动脉血乳酸含量。结果与基础值T0时比较,C组在T1~T6时SBP、DBP、CO均显著下降(P<0.05);E1组SBP、DBP在T1~T6时降低,CO在T1~T3时降低(P<0.05);E2、E3组HR、CO在T1~T6时上升显著(P<0.05)。与C组同一时点比较,E2、E3组SBP、DBP、CO在T1~T6时均升高,但E3组HR升高显著,差异有统计学意义(P<0.05)。与T0时及C组同时点比较,E2组动脉血乳酸含量降低,差异有统计学意义(P<0.05)。结论全麻纤支镜检查患者麻醉诱导即刻开始持续静脉泵注0.02μg/(kg·min)或0.025μg/(kg·min)肾上腺素均可缓解瑞芬太尼及丙泊酚麻醉引起的低血压,0.02μg/(kg·min)肾上腺素对心率影响相对较小。
Objective To investigate the effect of different doses of epinephrine on the hemodynamics during fiberoptic bronchoscopy under general anesthesia. Methods Eighty patients（ ASA I-II） undergoing fiberoptic bronchoscopy were randomly divided into 4 groups（ n = 20 each）,Group C,Group E1,Group E2 and Group E3. Anesthesia was performed with continuous intravenous drip of remifentanil and propofol monitored by bispectral index（ BIS） to maintain BIS at 40-60 in all groups. The patients in Group E1,Group E2 and Group E3 were all treated with a continuous intravenous drip of epinephrine at 0. 015 μg/（ kg·min）,0. 02 μg/（ kg·min） or 0. 025 μg/（ kg·min）,respectively,at the induction of general anesthesia. Systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）,heart rate（ HR） and cardiac output（ CO） were recorded at baseline（ T0）,1 min（ T1） and 2 min（ T2） after the induction of anesthesia,at the time of laryngeal mask placement（ T3）,when the tip of the bronchoscope reached glottis（ T4） and carina（ T5）,at end of the examination（ T6） and at awake（ T7）. The duration of anesthesia,duration of bronchoscopy and emergence time were recorded. The arterial lactate also tested at T0 and 7. Results Compared with those at T0,SBP,DBP and CO were significantly reduced at T1,2,3,4,5 and 6 in Group C（ P 〈 0. 05）. Compared with those at T0,SBP and DBP were significantly reduced at T1,2,3,4,5 and 6 in Group E1; while CO was significantly reduced at T1,2 and 3（ P 0. 05）. Compared with those at T0,HR and CO were significantly increased at T1,2,3,4,5 and 6 in both Group E2 and E3（ P 〈 0. 05）. Compared with Group C,SBP,DBP and CO were significantly increased at T1,2,3,4,5 and 6 in both Group E2 and E3,while HR was significantly increased at T1,2,3,4,5 and 6 in Group E3（ P 〈 0. 05）. The arterial lactate was significantly lower in Group E2 than that in Group C at T0（ P 〈 0. 05）. Conclusion Continuous intravenous drip of epinephrine at 0. 02
作者
易明亮
尹泓
赵聪
王建生
侯正友
王剑平
YI Ming- liang;YIN Hong;ZHAO Cong;WANG Jian- sheng;HOU Zheng- you;WANG Jian- ping.(Department of Anesthesiology, Chengdu Fifth Hospital, Chengdu 611130, Sichuan, China)
出处
《广东医学》
CAS
2018年第9期1315-1318,共4页
Guangdong Medical Journal
