咪唑安定、异丙酚对后颅窝手术后患者血流动力学的影响

目的探讨咪唑安定和异丙酚用于后颅窝手术后带气管插管患者镇静时对血流动力学的影响。方法将60例择期全麻后颅窝肿瘤手术后带气管插管躁动的患者用随机数字表法随机分为2组,咪唑安定组M组(n=30),异丙酚组P组(n=30)。分别首先给予咪唑安定0.05mg/kg或异丙酚0.5mg/kg静脉推注,再给予咪唑安定(0.05～0.2)mg/(kg·h),异丙酚(0.5～3)mg/(kg·h)持续微量泵泵入,维持Ramsay镇静评分2～3级,于镇静前、镇静后10min、30min,1h、2h、4h、8h记录Ramsay镇静评分、用药量、心率(heart rate,HR)、收缩压(systolic bloodpressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(meanarterialpressure,MAP),用胸阻抗法监测血流动力学参数心排血量(cardiac output,CO)、心脏指数(cardiac index,CI)、每搏输出量(stroke volume,SV)、体循环阻力(systemic vascular resistance,SVR)。结果静脉注射负荷剂量的异丙酚和咪唑安定后,病人的心率均显著下降,差异有统计学意义(P<0.05),SBP、DBP、MAP、CO和CI在镇静阶段均降低但差异无统计学意义,SV和SVR均升高但差异无统计学意义,组间比较差异无统计学意义。结论咪唑安定和异丙酚用于后颅窝术后带气管插管患者镇静时对血流动力学的影响很小且二者作用相当。

Comparison of Effects of Midazolam and Propofol on Hemodynamics in Postoperative and Tracheal Intubated Patients with Posterior Fossa Craniotomy

Objective To compare the effects of midazolam and propofol on hemodynamics in postoperative and tracheal intubated patients with posterior fossa craniotomy. Methods For 60 patients undergoing posterior fossa craniotomy with endotracheal intubation were randomly divided into 2 groups to receive either midazolam(group M, n=30) or propofol (group P, n=30). In group M and group P patients received induction of sedation with midazolam 0.05 mg/kg and propofol 0.5 mg/kg respectively, followed by midazolam 0.05 mg/(kg·h)~ 0.2 mg/(kg·h) and propofol 0.5 mg/(kg·h)~3 mg/(kg·h). Patients could reach level 2~3 of Ramsay sedative condition. Sedation parameters(Ramsay score) and hemodynamic parameters including heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial blood pressure(MAP), cardiac output(CO), cardiac index(CI), stroke volume(SV), systemic vascular resistance(SVR) were recorded before sedation, 10 min, 30 min, 1 h, 2 h, 4 h and 8 h after sedation. Results After sedation, HR significantly decreased in both groups(P<0.05). SBP, DBP, MAP, CO and CI insignificantly decreased in both groups, SV and SVR insignificantly increased in both groups. Conclusion The use of midazolam and propofol in postoperative and tracheal intubated patients with posterior fossa craniotomy sedation is safe and efficient. Both of them have moderate and equal effect on hemodynamics.