尼卡地平联合羟乙基淀粉容量填充对单纯静脉麻醉丙泊酚用量的影响观察

目的观察尼卡地平联合羟乙基淀粉容量填充对单纯静脉麻醉丙泊酚用量的影响。方法将87例择期进行脊柱手术患者随机分为对照组40例和观察组47例,两组在给予尼卡地平开始10-20min内快速静脉滴注10ml/kg羟乙基淀粉130/0.4进行容量填充。观察组在诱导前1min静脉输注尼卡地平10μg/kg,然后以1μg.kg-1.min-1微量泵注入;对照组在相同时间点注射相同剂量的生理盐水。调节丙泊酚浓度使手术中脑电双频指数（BIS）值控制在40-60的范围内。记录丙泊酚用量、拔管时间和清醒时间。结果观察组的丙泊酚用量（850.7±139.3ml）、清醒时间（6.2±2.5）h和拔管时间（8.1±2.6）h明显少于对照组,差异有统计学意义（P〈0.05）;观察组MAP平均值为82.5±15.7,明显比对照组93.5±17.6要低,差异有统计学意义（P〈0.05）;观察组HR平均值为90.6±10.5,明显高于对照组75.3±11.5,差异有统计学意义（P〈0.05）;观察组术中丙泊酚浓度平均值和BIS平均值分别为2.5±0.4μg/ml和52.8±3.4,分别低于和高于对照组的3.2±0.8μg/ml和47.5±8.1,差异有统计学意义（P〈0.05）。结论尼卡地平联合羟乙基淀粉容量填充对单纯静脉麻醉能减少脊柱手术丙泊酚用量,同时能够保持手术所需麻醉深度,维持血流血压的稳定性,缩短清醒时间和拔管时间,可为外科手术提供良好麻醉。

Effects of nicardipine,hydroxyethyl starch combined with volume expansion on propofol dosage during total intravenous anesthesia

Objective To investigate the effects of nicardipine hydroxyethyl starch combined with volume expansion on propofol dosage during total intravenous anesthesia. Methods 87 patients undergoing spinal surgery were randomly divided observation group（47 cases） and control group（40 cases）. All patients received volume expansion with hydroxyethyl starch 10ml/kg in 20rain after giving nicardipine. At 1 min before tracheal intubation,tbe patients were given a bolus of nicardipine 10gg/kg（observation group） or normal saline（control group）, observation group received 10gg/kg nicardipine followed by infusion of lgg.kg l.min ＇, while control group received the same volume of saline. Anesthesia was maintained with target-controlled by propofol BIS was contolled between 40-60. The consumption of propofol, recovery of consciousness and trachea extubation were recorded. Results The propofol dosage of observation group（850.7 ±139.3ml）, waking hours（6.2±2.5） and extubation time（8.1 ± 2.6） significantly less than in the control group, the difference was statistically significant（P〈0.05）, The observation group MAP average was 82.5±15.7, was obviously lower than the control group 93.5±17.6, it is statistically significant difference（P〈0.05） Observation group HR averages 90.6±10.5, is significantly higher than control group 75.3±11.5, difference has statistical significance（P〈0.05）, Observation group intraoperative propofol concentration average and BIS average are 2.5 ±0.4gg/ mi and 52.8±3.4, has difference with control group（P〈0.05）. Conclusion Nicardipine combined with hydroxyethyi starch on the volume expansion during induction could reduce cardiovascular respone, decrease propofol consumption and shorten the time of consciousness recovery and extubation in total intravenous anesthesia.