异丙酚不同诱导方法对气管插管时心血管反应的影响

为了探讨更合适的异丙酚诱导给药方案，本文观察了异丙酚不同给药方法对气管插管时心血管反应的影响。２２例成年患者，ＡＳＡ１～２级，常规术前用药后随机分为２组。Ａ组（ｎ＝１２）预先静注２μｇ／ｋｇ芬太尼（Ｆｅｎｔａｎｙｌ）后先以４ｍｌ（４０ｍｇ）／１０ｓ的速度静注异丙酚（Ｐｒｏｐｏｆｏｌ），当异丙酚用量达到１５ｍｇ／ｋｇ体重时停止给药１０ｓ，观察患者反应，若患者入睡则静注肌肉松驰剂，否则继续以２ｍｌ（２０ｍｇ）／１０ｓ的速度静注异丙酚直至患者入睡及眼睫毛反射消失后静注琥珀胆碱（２ｍｇ／ｋｇ）。Ｂ组（ｎ＝１０）仅以异丙酚及琥珀胆碱完成气管插管，两组患者均于静注完异丙酚后２ｍｉｎ实施气管插管。分别于诱导前（Ｔ０），注完异丙酚后１ｍｉｎ（Ｔ１），２ｍｉｎ（Ｔ２），气管插管即刻（Ｔ３）及气管插管后的３ｍｉｎ（Ｔ４）观察并记录ＨＲ，ＳＢＰ（收缩压），ＤＢＰ（舒张压），ＭＡＰ（平均压），并计算心率收缩压乘积（ＲＰＰ）以之间接反映心肌耗氧量。结果：Ａ组诱导后各时期ＨＲ，ＳＢＰ，ＭＡＰ，ＤＢＰ及ＲＰＰ无显著改变。Ｂ组诱导后ＨＲ呈逐渐上升趋势，Ｔ３时显著高于Ｔ０（Ｐ＜００５）；Ｔ３及Ｔ４时ＲＰＰ显著高于Ｔ０（Ｐ＜００１），Ｓ?

Effects of Different Propofol Induction Method on Cardiovascular Reactions

The cardiovascular effects of different management of propofol were investigated in order to find a more proper scheme of anesthesia induction with propofol. 22 adult patients, ASA grade 2 or 3, were divided randomly into 2 groups after premedication, Group A( n =12) and group B( n =10). Method: Patients in group A received fentanyl (2 μg/kg,intravenously) beforehand, then infused with propofol at a rate of 40 mg per 10 seconds ,paused for 10 seconds when the proposal dosage reached 1 5 mg/kg. If patients eyelash reflex disappeared, gave muscle relaxant, if not, continued to give propofol at a rate of 20 mg per 10 seconds until patients eyelash reflex disappeared. Then, gave succinylcholine(2 mg/kg)to carry out endotracheal intubation. Patients in group B were infused with proposal at a rate of 40 mg per 10 seconds until the disappearing of eyelash reflex and infused with succinylcholing(2 mg/kg) to finish endotracheal intubation. Endotracheal intubation was carried out 2 minutes after the infusion of proposal in all groups.HR, SBP, MAP and DBP were continuously observed and were respectively recorded at the time of preinduction(T 0), 1 min(T 1) and 2 min (T 2) after the infusion of propofol, the moment of endotracheal intubation(T 3) and 3 min after intubation(T 4), RPP (rate pressure product) was calculated to indirectly reflect heart oxygen consumption. Result: HR, SBP, MAP, DBP and RPP did not significantly changed after induction in group A.However, HR gradually increased in group B after induction, and significantly higher than its preinduction value( P <0 05). Also, the RPP values at T 3 and T 4 were both higher than its T 0 value ( P <0 01)in group B.Conclusion: Giving Fentanyl(2 μg/kg) in advance and then infusing propofol interruptedly at differtent rate can fully inhibit cardiovascular side effects of endotracheal intubation, reduce heart oxyen consumption and dont cause significant preintubation hypotension. Therefore, it is an ideal propofol induction method.