全麻诱导期间丙泊酚不同给药方法对血流动力学的影响

目的：探讨全麻诱导期间丙泊酚不同给药方法对血流动力学的影响.方法：120例择期行经皮肾镜取石术的患者,ASAⅠ～Ⅱ,分成三组：A组（依次静注咪达唑仑0.1 mg/kg,芬太尼4 μg/kg,阿曲库铵0.6 mg/kg,丙泊酚2 mg/kg,3 min后行气管插管）,B组（依次静注咪达唑仑0.1 mg/kg,芬太尼4 μg/kg,阿曲库铵0.6 mg/kg,丙泊酚1 mg/kg,3 min后追加丙泊酚1 mg/kg行气管插管）,C组（依次静注咪达唑仑0.1 mg/kg,芬太尼4 μg/kg,阿曲库铵0.6 mg/kg,3 min后静注丙泊酚2 mg/kg行气管插管）分别在麻醉诱导前,诱导后1 min、插管前、插管后即刻、插管后1 min、插管后3 min、插管后10 min监测MAP、HR、SPO2.结果：在麻醉诱导期间,A组MAP和HR变化幅度最大、B组变化幅度次之,C组变化幅度最小,三组间比较差异有统计学意义（P〈0.05）,而SPO2比较差异无统计学意义,术后24 h内随访三组患者均无诱导或手术期间术中知晓.结论：C组丙泊酚诱导给药方法可以明显减少MAP和HR波动,对全麻诱导期间血流动力学影响较小,是一种较好的给药方法.

Effect of different administration methods with propofol on hemodynamics during the induction of general anesthesia

Objective ：To investigate the effect of different medication of propofol on hemodynamics during the period of general anesthesia induction. Methods： 120 cases undergoing elective percutaneous nephrolithotomy, ASA I - II, divid- ed into three groups ： group A （ midazolam 0.1 mg/kg, fentanyl 4 μg/kg, atracurium 0.6 mg/kg, propofol 2 mg/kg was administered by intravenous one by one, endotracheal intubation after 3 min）, group B （midazolam 0.1 mg/kg, fentanyl 4 μg/kg, atracurium 0.6 mg/kg, propofol 1 mg/kg was administered by intravenous one by one, 3 min later additional propofol 1 mg/kg was administered by intravenous, then endotracheal intubation immediately ）, group C （ midazolam 0.1 mg/kg, fentanyl 4 μg/kg, atracurium 0.6 mg/kg was administered by intravenous one by one, waiting 3 min propo- fol 2 mg/kg was administered by intravenous, then endotracheal intubation immediately）. MAP, HR and SPO2 were de- tected respectively, before induction of anesthesia, 1 min after induction, before intubation, instant after intubation, 1 rain after intubation, 3 min after intubation, 10 min after intubation. Results：During the induction of anesthesia,the big- gest rangeability of MAP and HR was in group A, followed by group B, and the smallest rangeability in group C. There was significant difference in rangeability of MAP and HR between the three groups （P 〈 0.05）, then the rangeability of SPO2 was no significant difference in three groups （ P 〉 0.05 ）. There was no happen of intraoperative awareness follow- up within 24 h after induction in three groups. Conclusion： The medication of propofol in group C could obviously reduce fluctuations of MAP and HR, so the hemodynamics was effected less during induction of anesthesia, it was a better anes- thesia induction medication.