全麻诱导气管插管时大脑皮层电活动与血流动力学的变化

探讨数量化脑电图在反映麻醉诱导气管插管期间脑电的活动程度，以及ＥＥＧ和心血管反应相关性研究。方法：７０例ＡＳＡⅠ级病人，随机双盲分两组，组Ⅰ（ｎ＝３５）硫喷妥钠，组Ⅱ（ｎ＝３５）异丙酚。硫喷妥钠或异丙酚和琥珀胆碱行气管插管。分别于诱导前、诱导后，气导插管后１￣２分和３￣５分监测数量化脑电图，ＭＡＰ、ＨＲ、ＳｐＯ２的变化。结果：诱导前，两组病人的ＥＥＧ及血流动力学参数无差异。诱导后，ＥＥＧ抑制、ＳＥ     

异丙酚和硫喷妥钠用于全麻诱导及拔管时的比较

异丙酚和硫喷妥钠用于全麻诱导及拔管时的比较陈新民＊彭志勇＊刘俊杰＊本文将异丙酚用于全麻诱导及拔管，观察其麻醉效果及对呼吸、循环功能的影响，并与硫喷妥钠进行比较，为临床应用提供依据。资料与方法３０例ＡＳＡⅠ～Ⅱ级的择期全麻手术病人，男女各半，年龄３２～...     

硫喷妥钠用于全麻诱导时老年人和中青年人心血管反应的临床比较

本研究旨在了解老年人在硫喷妥钠诱导插管期间的心血管反应与中青年人有何区别。随机选择６０岁以下和６０岁以上的择期手术病人各１０例，即中青年组（Ａ组）和老年组（Ｂ组），两组均静注硫喷妥钠６～７ｍｇ／ｋｇ和琥珀酰胆碱１．５～２．０ｍｇ／ｋｇ后插管。应用ＢｏＭｅｄＮＣＣＯＭ３－Ｒ７无创心功能监测仪分别在诱导前、诱导后、插管后即刻和插管后１、５ｍｉｎ测定血流动力学参数。结果表明，应用一定剂量范围的硫喷妥钠诱导时，老年人的血压、ＣＩ、ＳＩ、ＬＣＷＩ、ＥＦ的下降程度并不比中青年人更显著。另外，老年人对插管刺激引起的高血压反应比中青年人剧烈，而其ＨＲ的上升幅度并不比中青年人显著，但如此也导致老年人的ＲＰＰ增加。因此，在老年病人为预防诱导插管期间心血管并发症的发生，应采取适当的措施来减轻插管刺激引起的心血管反应。     

氯硝西泮、硫喷妥钠在全麻诱导期间血流动力学变化的临床对照研究

<正> 在全麻诱导过程中,喉镜窥视和气管插管引起的心血管应激反应是潜在的危险因素之一,可引起突发性高血压和心率增快,对于缺血性心脏病和术前低血容量者可引起剧烈的血流动力学波动,甚至发生严重意外。本文旨在比较氯硝西泮与硫喷妥钠在全麻诱导气管插管过程中对血流力学的影响,观察并评价氯硝西泮对预防气管插管反应的临床效果与安全性。     

硫喷妥钠快速诱导气管插管期间血流动力学的变化

本文用无创性心阻抗血流图测量27例择期手术病人在硫喷妥钠快速诱导插管期间血流动力学的变化。结果显示静注硫喷妥钠8mg/kg后SBP、SI和CI分别下降10.6％(P<0.001)、38.5％(P<0.001)和16.3％(P<0.001);HR代偿性增快4O.5％(P<0.001);TPR和PCWP显著升高(P<0.05)。喉镜暴露声门及气管插管后血压、TPR、HR、PCWP进一步急剧增高,而SI和CI进一步减少。所以,对于高血压、冠心病、高颅内压、动脉瘤等病人应采取必要的预防措施,以免由于血流动力学的剧烈变化而发生意外。     

不同剂量异丙酚和硫喷妥钠静脉注射对血流动力学的影响

目的：研究异丙酚对血流动力学影响。方法：３０例病人（ＡＳＡⅠ～Ⅱ级）随机分为三组，第１组硫喷妥钠用量为５ｍｇ／ｋｇ，第２、３组异丙酚剂量分别为１．５ｍｇ／ｋｇ和２．５ｍｇ／ｋｇ，用阻抗法观察ＭＡＰ、ＨＲ、ＣＯ、ＣＩ、ＳＶ、ＳＩ、ＴＦＩ、ＶＥＴ、ＳＶＲ的变化。结果：注药后１０ｍｉｎＣＯ、ＣＩ、ＳＶ、ＳＩ等值在第１组下降２０％～３０％，第２组下降少于１０％，而第３组下降１０％～２０％。结论：异丙酚对循环系统影响轻于硫喷妥钠。     

硫喷妥钠用于全麻诱导时老年人和中青年人心血管反应的临床…

本研究旨在了解老年人在硫喷妥钠诱导插管期间的心血管反应与中青年人何区别。随机选择６０岁以下和６０岁以上的择期手术病人各１０例，即中青年组和老年组，两组均静注硫喷妥钠６－７ｍｇ／ｋｇ和琥珀酰胆碱１．５－２．０ｍｇ／ｋｇ后插管。应用ＢｏＭｅｄＮＣＣＯＭ３－Ｒ７无创心功能监测仪分别在诱导前，诱导后，插管后即刻和插管后１，５ｍｉｎ测定血流动力学参数。     

双异丙酚和硫喷妥钠诱导插管时血流动力学和血浆儿茶酚胺反应的比较

Vohra等报道用双异丙酚诱导时动脉压和周身血管阻力的下降比用硫喷妥钠更明显,但两药都使心脏指数下降,因此怀疑插管反应是由于儿茶酚胺释放所     

不同剂量异丙酚和硫喷妥钠静脉注对血流动力学的影响

目的：研究异丙酚对血流动力学影响。方法：３０例病人随机分为三组，第１组硫喷妥钠用量为５ｍｇ／ｋｇ，第２、３划丙酚剂量分别为１．５ｍｇ／ｋｇ和２．５ｍｇ／ｋｇ，用阻抗法观察ＭＡＰＨＲ、ＣＯ、ＣＩ、ＳＶ、ＳＩ、ＴＦＩ、ＶＥＴ、ＳＶＲ的变化。结果：注药后１０ｍｉｎＣｏ、Ｃｉ、ＳＶ、Ｓｉ等在第１组下降２０％－３０％，第２组下降少于１０％，而第３组下降１０－２０％。结论：异丙酚对循环系统影响轻于硫喷妥钠。     

异丙酚、硫喷妥钠预防气管插管危险性的临床随机对照研究

目的 比较异丙酚与硫喷妥钠预防拨管插的危险性的效果。方法 选择全麻气管插管手术病人２２４例，观察异丙酚２．０ｍｇ／ｋｇ复合芬太尼２μｇ／ｋｇ的气管插管危险性，并采用多因素分析与硫喷妥钠５．０ｍｇ／ｋｇ复合芬太尼２μｇ／ｋｇ进行比较。结果 硫喷妥钠组不率为８５．５９％，异丙酚组为８１．４２％，组间无显著性差异（Ｐ〉０．０５），除外低血压症，硫喷妥钠组不满意率为７９．２８％，异丙酚分别为４５．１３％，     

异丙酚 硫喷妥钠 依托咪酯用于腹腔镜胆囊切除术麻醉的临床对比研究

目的:评估和比较异丙酚,硫喷妥钠和依托咪酯用于腹腔镜胆囊切除术麻醉中的诱导,麻醉稳定性,苏醒和麻醉并发症。方法:选择60例行腹腔镜胆囊切除术的病人,随机分为三组,一组硫喷妥钠用于麻醉诱导,30％N_2O—七氟醚用于麻醉维持。二组异丙酚用于麻醉诱导和维持。三组依托咪酯用于麻醉诱导和维持。结果:各组诱导意识消失时间依次为37.7±1.0秒,49.9±1.8秒,57.3±2.0秒,麻醉后睁眼时间依次为13.9±0.8分。9.4±0.4分,12.3±0.7分。各组间比较差异均有显著性P均<0.01。异丙酚组苏醒后无一例复睡。结论:异丙酚诱导迅速,可以提供一个稳定的腹腔镜麻醉,而不需要大量的其它静脉麻醉药,苏醒最快,且苏醒质量好,术后并发症少。     

胸阻抗法监测咪唑安定及丙泊酚静脉全麻诱导过程中血流动力学变化

目的研究丙泊酚及咪唑安定静脉全麻诱导过程中对病人血流动力学变化的影响。方法年龄18~65岁、ASAⅠ或Ⅱ级的择期手术病人50例,随机分成丙泊酚组(A组)和咪唑安定组(B组),每组25例,分别以丙泊酚1.5mg/kg或咪唑安定0.2mg/kg进行诱导,用胸阻抗法监测麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)时的体循环阻力(SVR)、左心作功(LCW)、心排血量(CO)、心脏指数(CI)、SBP、DBP和HR的变化。结果两组病人在全麻诱导过程中SBP、SVR、CO、LCW差异无统计学意义,B组HR在T1、T2、T4及T5时明显快于A组(P<0.05或P<0.01)。结论0.2mg/kg咪唑安定与1.5mg/kg丙泊酚进行全麻诱导对血流动力学的影响基本一致。     

Intubating conditions and haemodynamic changes following thiopentone or propofol for early tracheal intubation

Intubating conditions and haemodynamic changes were studied 30 sec after a fixed induction dose of thiopentone or propofol in patients scheduled for elective surgery. The hypnotic agent was preceded by the administration of papaveretum 10 mg three minutes before induction and alcuronium 0.2 mg·kg^?1 at induction. Ease of intubation was graded and the study conducted in a randomised double-blind fashion. In the thiopentone group (n=30) intubation was very easy in 73% compared with 79% in the propofol group (n=29). In two patients in the propofol group the tracheas were moderately difficult to intubate but there were no failed intubations in either group. No patients recalled the intubation period on subsequent postoperative questioning. The immediate post-induction average systolic pressure in the thiopentone group decreased by 0.7% (range 15.9% increase to 25.3% decrease) whilst the post-intubation systolic pressure increased by 6.3% (range ?31.5% increase to 24.2% decrease). In the propofol group there was a decrease in systolic pressure after induction (average 14.4%; range 15.5% increase to 41.4% decrease, P < 0.05) but the subsequent pressor response to intubation was markedly attenuated compared with baseline (average systolic pressure decreased 15.5% (range 22.4% increase to 42.7% decrease)). Following intubation and maintenance, ventilation with nitrous oxide 70% and halothane 1% the systolic pressure decreased markedly in both groups with a greater reduction in the propofol group (P < 0.05). Compared with baseline there were increases (P < 0.0001) in heart rate in both groups from induction of anaesthesia to the end of study. The results show that early tracheal intubation can be undertaken following thiopentone and is accompanied by haemodynamic stability. Comparable intubating conditions are associated with propofol but the dose used resulted in a considerable decrease in systolic blood pressure after induction.     

异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响

目的比较异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响，寻找瑞芬太尼复合异丙酚气管插管的合适剂量。方法择期行腹腔镜胆囊切除术病人36例，ASAⅠ或Ⅱ级，年龄20～65岁，随机分为3组（n=12）：瑞芬太尼1、1．5、2μg／kg分别为复合异丙酚1．5μg／kg组（Ⅰ、Ⅱ、Ⅲ组）。依次静脉注射咪唑安定0．03mg／kg、异丙酚1．5mg/kg、维库溴铵0．1mg／kg以及瑞芬太尼麻醉诱导，2min后气管插管，进行机械通气，呼吸频率12次／min，潮气量8～10ml／kg，维持呼气末二氧化碳分压35～45mmHg。持续监测血压（平均动脉压、舒张压、收缩压）、心率（HR）以及听觉诱发电位指数（AAI），并记录病人有无气管插管时呛咳和肌肉强直、术中知晓等反应。结果与基础值比较，三组气管插管前即刻血压及Ⅲ组气管插管后即刻舒张压均降低，Ⅲ组气管插管后即刻血压低于Ⅰ组（P〈0．05）；HR组间及组内比较差异无统计学意义；三组间AAI差异无统计学意义。结论异丙酚1．5mg／kg麻醉诱导期间瑞芬太尼1或1．5μg／kg是病人气管插管时的合适剂量。     

Electroencephalographic changes during anesthesia with low-dose propofol

The electroencephalographic changes of 12 patients submitted to anaesthesia with low dosages of propofol (4-2 mg/kg/h + fentanyl) for peripheral vascular surgery have been studied. The standard induction dose of propofol was 2 mg/kg for all the patients. The EEG recording was carried out during the whole length of anaesthesia and the EEG changes were analysed during induction and maintenance phases. During surgical anaesthesia it was always easy to read EEG and also to detect eventual cerebral suffering. On the basis of our results we can suggest this anesthesiologic technique for surgery (for example: carotid surgery) requiring a continuous monitoring of the cerebral function during intra and postoperative phases.     

异丙酚诱导插管对血浆降钙素基因相关肽及内皮素水平的影响

目的 探讨异丙酚诱导插管对血浆ＣＧＲＰ含量的影响。方法 择期手术病人３６例,ＡＳＡⅠ～Ⅱ级,随机分为异丙酚（ＰＰ组,２０例）硫喷妥钠（ＳＰ组,１６例）两组,分别于麻醉前、用药后、插管后２ｍｉｎ、７ｍｉｎ、１５ｍｉｎ测定血浆中ＣＧＲＰ、ＥＴ的含理及血液动力学变化。结果 两组给药后血压均下降,插管后硫喷妥钠组血压迅速上升,异丙酚组插管后ＣＧＲＰ、ＥＴ含量略有下降,但无统计学意义（Ｐ〉０．０５）。硫喷妥     

Hemodynamic stability during induction of anesthesia and tracheal intubation with propofol plus fentanyl, ketamine, and fentanyl-ketamine

Purpose. This study was conducted to investigate hemodynamic and cardiac stability during anesthesia induction and intubation, using propofol plus fentanyl, propofol plus ketamine, and propofol plus fentanyl and ketamine. Methods. Forty-five adult patients were randomly allocated to one of three groups according to the agents used for induction: propofol (2 mg/kg) plus fentanyl (3 μg/kg) (PF), propofol (2 mg/kg) plus ketamine (0.1 mg/kg) (PK), and propofol (2 mg/kg) plus fentanyl (3 μg/kg) plus ketamine (0.1 mg/kg) (PFK). Hemodynamic responses were assessed by measuring changes in blood pressure (BP), heart rate (HR), and cardiac output (CO; using dye dilution combined with pulse dye densitometry [PDD]). Results. BP and HR changes during the induction of anesthesia tended to be greater in the PK group than in the PF and PFK groups. After the injection of propofol, the cardiac index (CI) fell significantly below baseline values in the PF and PFK groups, but remained unchanged in the PK group. After tracheal intubation, BP and HR increased significantly only in the PF and PK groups, and reached a level significantly above baseline values only in the PK group. The CO responses to tracheal intubation were: PK group > PF group > PFK group. Conclusion. A combination of propofol plus fentanyl plus ketamine would provide greater reduction of fluctuations in hemodynamic variables associated with induction of anesthesia and tracheal intubation than combinations of propofol plus fentanyl or propofol plus ketamine. Received: January 22, 2001 / Accepted: June 19, 2001