不同剂量芬太尼和依托咪酯复合诱导气管插管对神经外科患者脑血流动力学的影响研究

目的探讨不同剂量芬太尼和依托咪酯复合诱导气管插管对神经外科患者脑血流动力学的影响。方法选择2012—2013年我院神经外科收治的需气管插管全醉的成年患者64例,将其随机分为A组20例(芬太尼1μg/kg)、B组22例(芬太尼2μg/kg)、C组22例(芬太尼3μg/kg)。A、B、C组患者在1 min内分别静脉注射芬太尼1μg/kg、2μg/kg、3μg/kg,30 s后静脉给予依托咪酯0.3 mg/kg、维库溴胺0.1 mg/kg,3 min后进行气管插管。记录3组患者在手术室静卧(T0)、麻醉诱导前(T1)、插管即刻(T2)及插管1 min(T3)时的血流动力学指标〔收缩压(SBP)、舒张压(DBP)及心率(HR)〕和脑血流动力学指标〔收缩峰值血流速度(Vp)、舒张期血流速度(Vd)、平均血流速度(Vm)、搏动指数(PI)和阻力指数(RI)〕。结果 T0时各组Vp、Vd、Vm、PI和RI比较,差异无统计学意义(P0.05);T1、T2及T3时B和C组Vp、Vd、Vm低于A组,RI高于A组(P0.05)。T0时各组SBP、DBP和HR比较,差异无统计学意义(P0.05)。T1、T2和T3时B和C组SBP低于A组(P0.05)。结论不同剂量芬太尼和依托咪酯复合诱导气管插管对神经外科患者均有良好的效果,其中2~3μg/kg芬太尼麻醉诱导能更加有效地稳定患者脑血流动力学指标。

Effect of Different Doses of Fentanyl and Etomidate Induced Anesthesia on Cerebral Hemodynamics in Tracheal Intuba-tion Patients from Department of Neurosurgery

Objective To explore the effect of different doses of fentanyl and etomidate induced anesthesia on cerebral hemodynamics in tracheal intubation patients from Department of Neurosurgery. Methods From 2012 to 2013,64 adult patients required endotracheal intubation were selected in Department of Neurosurgery in our hospital,and they were randomly divided in-to group A（fentanyl 1 μg/kg,n=20）,group B（fentanyl 2 μg/kg,n=22）and group C（fentanyl 3 μg/kg,n=22）. Groups A,B,C given intravenous injection of fentanyl 1 μg/kg,2 μg/kg,3 μg/kg,respectively within 1 min,and intrave-nous injection of etomidate 0. 3 mg/kg and vecuronium 0. 1 mg/kg after 30 s;then given tracheal intubation after 3 min. Hemodynamic parameters（ SBP,DBP and HR）and cerebral hemodynamic parameters（ Vp,Vd,Vm,PI and RI）were recorded at the operating room（ T0 ）,before anesthesia（ T1 ）,at tracheal intubation（ T2 ） and 1 min after tracheal intubation （ T3 ）of the three groups. Results There was no significant difference in Vp,Vd,Vm,PI and RI in the three groups at T0 （P﹥0. 05）;at T1,T2 and T3,Vp,Vd,Vm in groups B and C were lower than those of group A,RI was higher than that of group A（P﹤0. 05）. There was no significant difference in SBP,DBP and HR in the three groups at T0（P﹥0. 05）;at T1, T2 and T3,SBP in groups B and C was lower than that of group A,respectively（P﹤0. 05）. Conclusion Different doses of fentanyl and etomidate induced anesthesia have a good effect on cerebral hemodynamics in tracheal intubation patients from De-partment of Neurosurgery,2~3 μg/kg of fentanyl induced anesthesia is better.