地氟醚与丙泊酚及舒芬太尼联合诱导对患者血流动力学的影响

目的：探讨地氟醚与丙泊酚联合诱导对MAP、HR及BIS的影响，以期达到循环稳定和达到气管插管所需麻醉深度的目的。方法选择择期甲状腺瘤切除手术患者60例,ASAⅠ～Ⅱ级,随机分为丙泊酚组(P组)和地氟醚+丙泊酚组(D+P组)，每组30例。全麻诱导：所有患者静脉注射咪达唑仑0.03 mg/kg ，10 min后P组(丙泊酚）静脉注射舒芬太尼0.4μg/kg,丙泊酚2 mg/kg,顺式阿曲库铵0.15 mg/kg；D+P组(地氟醚+丙泊酚)静脉注射舒芬太尼0.4μg/kg,异丙酚0.5 mg/kg,顺式阿曲库铵0.15 mg/kg，两组静脉注药时间均为1分钟。然后D+P组(地氟醚+丙泊酚)开启地氟醚蒸发罐刻度至12%，氧流量8 L/min。所有患者均于静脉注药结束4 min后行气管插管。插管后关闭地氟醚蒸发罐，维持新鲜氧流量2 L/min,潮气量8～10 mL/kg,调整呼吸频率或潮气量维持呼气末CO2分压35～45 mmHg。记录所有患者麻醉诱导前(T0)、诱导后插管前(T1)、插管后1 min(T2)、插管后3 min(T3)的MAP和HR和BIS。结果与基础值相比，两组患者MAP在T1时均降低，在T2时均升高，P组(丙泊酚）变化较D+P组(地氟醚+丙泊酚)明显（P＜0.05），MAP在T1时降至（68.1±8.1）mmHg；两组HR在 T1时均减慢（P＜0.05），在T2时均加快，但两组间差异无统计学意义；两组BIS值在T1均在45以下，组间比较差异有统计学意义（P＜0.05）,但无临床意义。结论地氟醚与丙泊酚及舒芬太尼联合诱导可维持循环相对稳定并可达到气管插管所需的麻醉深度。

The influence on MAP,HR, and BIS by the desflurane and propofol,sufentanil combined inductionon

Objective To investigate effects of anesthesia induction with desflurane inhalation in combination with propofol and sufentanil on MAP, HR and BIS, and the cardiovascular responses to endotracheal intubation in patients undergoing thyroidade-noma resection surgery. Methods Sixty ASAⅠ-Ⅱpatients of both sexes (9 male,51 female) aged 25-58years undergoing elective thyroidadenoma resection surgery were enrolled in this study. The patients were unpremedicated and were sedated with intravenous midazolam 0.03 mg/kg. During induction of general anesthesia they were randomized divided into propofol group P (group P,n=30) and desflurane+propofol group (group D+P,n=30). In group P, general anesthesia was induced with propofol 2 mg/kg, sufentanil 0.4μg/kg and cisatracurium 0.15 mg/kg. In group D+P, general anesthesia was induced with propofol 0.5 mg/kg, sufentanil 0.4μg/kg and cisatracurium 0.15 mg/kg, in combination with inhalation of 12%desflurane for 4 min, keeping the oxygen flow 8 L/min. En-dotracheal intubation was performed when the BIS value less than 45. BIS, MAP and HR were recorded before induction (T0, base-line), point of after induction and before intubation (T1), 1min after intubation (T2),3 min after intubation(T3). Results As compared with T0, MAP and HR were significantly decreased at T1, and were significantly increased at T2 in both groups(P<0.05). Compared with group P, MAP in group D+P was remarkably higher at T1 , however, was remarkably lower at T2 , showing group differences be-tween two groups (P<0.05). BIS values were both lower than 45 in both groups at T1. Conclusion Anesthesia induction with desflu-rane inhalation in combination with propofol and sufentanil presents rational BIS value and maintains hemodynamic stability during general anesthesia inductionon and endotracheal intubation.