丙泊酚靶控输注对创伤患者二期手术麻醉诱导的影响

目的观察重度创伤患者二期手术时丙泊酚诱导过程中脑电双频指数(BIS)及血液动力学的变化。方法选择重度创伤后7～14天,拟行二期手术的患者19例为创伤组,19例无创伤史行择期手术的患者为对照组。所有患者入室后行BIS及常规心电图、有创动脉血压、血氧饱和度监测,以丙泊酚效应室浓度靶控输注进行诱导,靶控浓度从0.5μg/ml开始,每3min增加0.5μg/ml,直到3.5μg/ml,记录诱导前及每个浓度下的BIS值、HR及收缩压。结果对照组靶控浓度≥3.0μg/ml及创伤组靶控浓度≥2.0μg/ml时的SBP与诱导前比较,差异有高度显著性;两组间靶控浓度为3.0μg/ml及3.5μg/ml时BIS及SBP差异有高度显著性。结论初期复苏后的重度创伤患者对丙泊酚的药效学有很大改变,丙泊酚靶控输注在这类患者应更加慎重。

Effects of propofol target-controlled infusion on patients with trauma undergoing secondary operation

Objective To observe bispectral index （BIS） and hemodynamic changes in patients during secondary operation with propofol - induction Methods 7- 14 days after severe trauma, 19 cases with secondary operation were enrolled in trauma group, 19 cases with non- invasive surgery history were enrolled in the control group. BIS, electrocardiogram, invasive arterial blood pressure and oxygen saturation monitoring were performed for all patients. Target - controlled infusion with propofol by effect - site concentration was used as anesthesia induction, target - controlled concentration began with 0.5μg/ml, adding 0.5μg/ml every three minutes, up to 3.5μg/ml. BIS values, HR and systolic blood pressure were recorded before anesthesia induction, and at time points of each concentration. Results SBP at target concentration of ≥3.0μg/ml in tion of ≥2.0μg/ml in trauma group were lower than those before control group and at target- controlled concentrainduction, there werestatistically significant difference; BIS and SBP at target control concentration of 3.0μg/ml and 3.5μg/ml differed significantly between the two groups Conclusion After early resuscitation from severe trauma, patients＇ propofol pharmacodynamics changed greatly and propofol target- controlled infusion in such kind of patients should be much more careful.