丙泊酚联合去氧肾上腺素诱导在眼科全麻手术中对血流动力学的影响

目的　探究丙泊酚联合去氧肾上腺素诱导在眼科全身麻醉（全麻）手术中对血流动力学的影响。方法　回顾性分析，选择2019年3月至2020年10月济南市第二人民医院220例眼科全麻手术患者作为研究对象，按照麻醉药物类别分为两组，各110例。对照组男70例、女40例，年龄（40.35±6.54）岁，给予丙泊酚+顺式阿曲库铵麻醉诱导；观察组男65例、女45例，年龄（40.79±6.13）岁，给予丙泊酚+去氧肾上腺素麻醉诱导。对比分析两组患者麻醉有效率，术后恢复情况以及不同时间点患者血流动力学、心率。采用独立样本t检验、χ²检验。结果　观察组麻醉有效率为98.18%（108/110），高于对照组91.82%（101/110），差异有统计学意义（χ²=4.689，P=0.030）。麻醉诱导后（T1）、喉罩置入后5 min（T2）、手术后10 min（T3），观察组收缩压（SBP）分别为（108.45±9.45）mmHg（1 mmHg=0.133 kPa）、（108.65±8.12）mmHg、（109.65±7.45）mmHg，均明显低于对照组（116.56±9.26）mmHg、（126.59±8.45）mmHg、（112.36±7.65）mmHg，舒张压（DBP）分别为（73.89±4.82）mmHg、（75.89±4.35）mmHg、（76.59±7.56）mmHg，均明显高于对照组（72.01±4.67）mmHg、（73.12±4.95）mmHg、（74.65±7.95）mmHg，平均动脉压（MAP）分别为（75.64±5.15）mmHg、（82.63±7.23）mmHg、（83.45±6.95）mmHg，均明显高于对照组（71.55±4.96）mmHg、（76.32±6.54）mmHg、（80.12±5.84）mmHg，心率（HR）分别为（72.14±5.26）次/min、（68.02±5.26）次/min、（70.26±5.49）次/min，均明显低于对照组（79.45±5.64）次/min、（85.31±5.64）次/min、（75.84±5.95）次/min，差异均有统计学意义（均P<0.05）。手术后，观察组睁眼时间（7.12±1.67）min、清醒时间（5.15±1.21）min，对照组睁眼时间（9.46±2.35）min、清醒时间（11.46±3.15）min，两组比较差异均有统计学意义（均P<0.05）。两组均未发生严重不良反应，出现轻微头痛、血压下降、胃肠道不适、呼吸抑制，药效消失后症状逐步缓解。结论　采用丙泊酚联合去氧肾上腺素进行麻醉诱导，有利于改善眼科全麻手术患者的血流动力学情况，有利于术后患者恢复清醒，保证术中麻醉疗效，且用药安全性尚可。

Effect of propofol combined with phenylephrine induction on hemodynamicsduring ophthalmic general anesthesia surgery

Objective　To explore the effect of propofol combined with phenylephrine inductionon hemodynamics during ophthalmic general anesthesia surgery. Methods　It was a retrospective analysis. From March 2019to October 2020, 220 patients undergoing ophthalmic general anesthesia surgeryin Jinan Second People's Hospital were selected as the study subjects, and weredivided into two groups according to the anesthesia drugs. In the controlgroup, there were 70 males and 40 females, with an age of (40.35±6.54) yearsold; in the observation group, there were 65 males and 45 females, with an ageof (40.79±6.13) years old. The control group was given propofol +cis-atracurium anesthesia induction, and the observation group was givenpropofol + phenylephrine anesthesia induction. The anesthesia efficiency,postoperative recovery, and hemodynamics and heart rate (HR) at different timepoints were compared between the two groups. Independent sample t test and χ² test were used. Results　The effective rate ofanesthesia in the observation group was 98.18% (108/110), which was higher thanthat in the control group [91.82% (101/110)], with a statistically significantdifference (χ²=4.689, P=0.030). The systolic blood pressures(SBP) of the observation group after induction of anesthesia (T1), 5 min afterlaryngeal mask placement (T2), and 10 min after surgery (T3) were (108.45±9.45)mmHg (1 mmHg=0.133 kPa), (108.65±8.12) mmHg, and (109.65±7.45) mmHg, which weresignificantly lower than those of the control group [(116.56±9.26) mmHg,(126.59±8.45) mmHg, and (112.36±7.65) mmHg], the diastolic blood pressures(DBP) were (73.89±4.82) mmHg, (75.89±4.35) mmHg, and (76.59±7.56) mmHg, whichwere significantly higher than those of the control group [(72.01±4.67) mmHg,(73.12±4.95) mmHg, and (74.65±7.95) mmHg], the mean arterial pressures (MAP)were (75.64±5.15) mmHg, (82.63±7.23) mmHg, and (83.45±6.95) mmHg, which weresignificantly higher than those of the control group [(71.55±4.96) mmHg,(76.32±6.54) mmHg, and (80.12±5.84) mmHg], and the heart rates (HR) were(72.14±5.26) beats/min, (68.02±5.26) beats/min, and (70.26±5.49) beats/min,which were significantly lower than those of the control group [(79.45±5.64)beats/min, (85.31±5.64) beats/min, (75.84±5.95) beats/min], with statisticallysignificant differences (all P<0.05).After surgery, the eye opening time and waking time of the observation groupwere (7.12±1.67) min and (5.15±1.21) min, and those of the control group were(9.46±2.35) min and (11.46±3.15) min, with statistically significantdifferences between the two groups (both P<0.05).No serious adverse reactions occurred in the two groups, and symptoms such asmild headache, decreased blood pressure, gastrointestinal discomfort, andrespiratory depression gradually relieved after the disappearance of thepesticide effect. Conclusion　The use of propofolcombined with phenylephrine for anesthesia induction is beneficial to improvethe hemodynamics in patients undergoing ophthalmic general anesthesia surgery,to restore their postoperative consciousness, and to ensure the efficacy ofintraoperative anesthesia, with acceptable safety of drug use.