创伤休克患者不同麻醉深度下诱导插管的血流动力学变化

目的 比较创伤休克患者在不同麻醉深度下诱导插管时的血流动力学变化. 方法 根据进入手术室的时序,按区段随机分组法将40例非颅脑损伤的创伤休克患者随机分为A、B两组,每组各20例.患者入室后行脑电双频指数(bispectral index,BIS)监测,麻醉诱导以咪达唑仑1.5 mg/min缓慢静注,当BIS达到预定值(A组60±3,B组45±3)时立即给予芬太尼3μg/kg、琥珀胆碱1.5mg/kg,肌肉松弛后气管插管.分别记录两组入室时(T0)、BIS达预定值时(T1)、气管插管即刻(T2)、插管后1 min(T3)、插管后3 min(T4)的BIS值、心率(HR)、收缩压(SBP)和咪达唑仑的用量. 结果 组内比较A组各时点HR、SBP差异无统计学意义,B组T1(138±15)次/分]、T2(146±15)次/分]、T3(147±11)次/分]、T4(146±10)次/分]时点的HR较T0(127±16)次/分]明显增加,而T2(72±10)mm Hg(1 mm Hg=0.133 kpa)]、T3(74±10)mm Hg]、T4(76±11)mm Hg]时点的SBP较T0(82±7)mm Hg]明显下降(P<0.05);两组间HR的差异出现在T3(P=0.005)、T4(P<0.001)时点;两组间SBP的差异出现在T4(P=0.005)时点.A组咪达唑仑用量约为0.117 mg/kg,较B组减少约17%(P<0.001). 结论 麻醉诱导插管时采用相对较浅的麻醉深度(BIS=60)更有利于创伤休克患者血流动力学的相对平稳.

Effects of different depths of anesthesia on hemodynamics in patients with traumatic shock during induction

Objective To compare the effects of different depths of anesthesia on hemodynamics during induction in traumatic shock patients. Methods 40 traumatic shock patients without craniocerebral injury were randomly assigned to group A and B(n=20 per group). Bispectral index (BIS) monitoring was applied to all cases as soon as they entered the operating room (OR). Then general anesthesia was induced with midazolam through a slow intravenous injection ( 1.5 mg/min, iv ). When the BIS reached the predetermined values (60±3 for group A and 45±3 for group B) ,fentanyl (3 μg/kg) and succinylcholine ( 1.5 mg/kg) were administered, following tracheal intubation after muscle relaxation. BIS values, heart rate (HR), systolic blood pressure (SBP), and midazolam doses were recorded at various time points: after patients entered OR (T0), when BIS reached predetermined values (T1), and tracheal intubation (T2), 1 min (T3) and 3 min (T4) after intubation. Results There were no statistically significant differences between the HR, SBP at different time points in group A. For group B the HR at T1 ( 138± 15 ) 、T2( 146± 15 ) 、T3( 147± 11 ) 、T4(146±10) were significantly increased compared with T0(127±16), and the SBP at T2 (72±10) mmHg( 1 mm Hg=0.133 Kpa) ]、 T3(74±10) mmHg]、T4 (76±11 ) mmHg]were significantly decreased compared with T0 ( 82±7 ) mmHg ] (P<0.05). The difference of HR was observed at T3 (P=0.005), T4 (P<0.001 )and the SBP differences appeared at T4 (P=0.005)between the two groups. The midazolam dose of group A was approximately 0.117 mg/kg, about 17% lower than that of group B. Conclusion Patients with traumatic shock may benefit from relatively shallow depth of anesthesia(BIS=60) for more stable hemodynamics during intubation.