丙泊酚和依托咪酯联合靶控诱导对高血压患者的影响

发布时间：2018-03-03 08:55

  本文选题：依托咪酯　切入点：丙泊酚　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：本研究采用随机、单盲设计,使用迈瑞无创血流动力学监测系统及BIS监测仪监测,应用丙泊酚、依托咪酯乳剂及两种药物以各50%血浆浓度靶控输注三种方法,观察高血压患者全麻诱导期间血流动力学改变、麻醉深度及不良反应的影响,评价这三种诱导方法在高血压患者中的应用价值。 方法：本研究经医院伦理委员会批准,选取ASA Ⅱ级,有高血压病史择期全麻手术腹腔镜下胆囊切除术患者60例,患者术前均规律服用降压药。随机分为三组,丙泊酚组(P组),依托咪酯(E组),联合组(PE组),每组20例。三组分别采用丙泊酚3ug/ml、依托咪酯0.6ug/ml、丙泊酚联合依托咪酯各50%血浆靶控浓度输注诱导。分别于麻醉诱导前(TO,基础值)、喉镜置入前即刻(T1)、插管后即刻(T2)、插管后1min(T3)、5min(T4),观察患者心率、平均动脉压、收缩压、舒张压、BIS值的变化以及每博输出量,心指数,外周血管阻力指数；同时记录患者有无注射痛、肌肉阵挛等不良反应发生,以及从注药开始到睫毛反射消失的时间。 结果：1、一般情况：三组患者身高、体重、年龄、在诱导前(时间点T0)的平均动脉压、收缩压、心输出量、每博输出量、外周血管阻力指数和心率均无统计学意义(P0.05)。 2、三组患者开始静脉输注镇静催眠药至眼睑反射消失时间的比较,PE组眼睑反射消失时间明显短于P组和E组(P0.05)。 3、三组患者在麻醉诱导期间血流动力学变化的比较：①三组患者在麻醉诱导期间心率的比较,P组的心率在喉镜置入前即刻低于E组与PE组,差异有统计学意义(P0.05)。E组的心率在插管即刻至插管后(T2-T4)高于P组和PE组(P0.05)。PE组在喉镜置入前即刻与插管后比较无统计学差异(P0.05)。②三组患者在麻醉诱导期间的平均动脉压比较,P组在插管期间和插管后(T1-T4)的平均动脉压低于E组和PE组(P0.05)。在插管即刻(T2)E组平均动脉压高于P组和PE组(P0.05)。③三组患者收缩压的比较,E组在置入喉镜即刻至插管期间(T1-T4)的收缩压高于P组和PE组,有统计学差异(P0.05)。④三组患者舒张压的比较,P组在置入喉镜即刻至插管期间(T1-T4)的舒张压低于E组和PE组,有统计学差异(P0.05)。PE组在置入喉镜即刻至插管期间(T1-T4)的舒张压与E组比较无统计学差异(P0.05)。⑤三组患者每博输出量的比较,P组在置入喉镜即刻至插管期间(T1～T4)的每博输出量低于E组和PE组,有统计学差异(P0.05)。PE组在置入喉镜即刻至插管期间(T1～T4)的每博输出量(SV)与E组比较无统计学差异(P0.05)。PE组在喉镜置入前(T1)与插管时(T2)比较无统计学差异(P0.05)。⑥三组患者心指数的比较,P组在喉镜置入前和插管后(T1～T4)的心指数低于PE组和E组(P0.05)。PE组心指数在喉镜置入前即刻与插管后即刻(T1和T2)与E组比较无统计学差异(P0.05),与P组比较有统计学差异(P0.05)。⑦三组患者外周血管阻力指数的比较,P组在喉镜置入前和插管后(T1～T4)的外周血管阻力指数低于PE组和E组(P0.05)。PE组外周血管阻力指数在喉镜置入前和插管后(T1～T4)与E组比较无统计学差异(P0.05),与P组比较有统计学差异(P0.05)。⑧三组患者循环波动情况P组的循环波动发生例数高于PE组,有统计学差异(P0.05)。 4.麻醉深度的比较：三组患者在麻醉诱导期间BIS值的比较,在诱导前、插管期间和插管后(T0～T4)的三组BIS值比较,均无统计学差异(P0.05)。 5.副作用的比较①三组患者注射痛的发生率比较,P组注射痛发生率高于PE组(P0.05)。②三组患者肌阵挛的发生率比较,P组、PE组肌阵挛发生率低于E组(P0.05)。 结论：丙泊酚和依托咪酯乳剂联合靶控输注用于高血压患者的全麻诱导与单独使用丙泊酚或依托咪酯乳剂相比,可以获得相对稳定的血流动力学稳定特征,并且减少静脉麻醉药注射痛和肌阵挛副作用的发生率,可以作为高血压患者全身麻醉诱导的一种较好的麻醉诱导方法。
[Abstract]:Objective: This study used a randomized, single blind design, the use of MINDRAY noninvasive hemodynamic monitoring system and BIS monitoring, the application of propofol, etomidate and two kinds of drugs in the 50% plasma concentration of target controlled infusion of three methods, observed during induction of anesthesia in patients with hypertension and hemodynamic changes, affect the depth of anesthesia and adverse reactions. The application value of the three induction methods of evaluation in patients with hypertension.
Methods: This study was approved by the hospital ethics committee, selected ASA grade II, 60 cases of patients undergoing resection of hypertension undergoing elective surgery under general anesthesia laparoscopic cholecystectomy, the patients were regularly taking antihypertensive drugs. Were randomly divided into three groups: Propofol group (group P), etomidate (E group), combination group (PE group), 20 cases in each group. The three groups were used propofol 3ug/ml 0.6ug/ml, etomidate, propofol etomidate combined the 50% plasma target concentration infusion induced. Respectively before induction of anesthesia (TO, baseline), immediately before laryngoscopy (T1), immediately after intubation (T2), 1min after intubation (T3), 5min (T4), observed in patients with heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, the change of BIS value and stroke volume, cardiac index, peripheral vascular resistance index; there is no injection pain were recorded at the same time, the adverse reaction of muscle clonus occurred, and the time from the injection to the eyelash reflex.
Results: 1, general situation: three groups of patients had no significant difference in height, weight, age, mean arterial pressure, systolic blood pressure, cardiac output, output per hour, peripheral vascular resistance index and heart rate before induction (time T0) (P0.05).
2, three groups of patients to comparison of intravenous infusion of sedatives to eyelid reflex time, PE group the eyelid reflex time was significantly shorter in the P group and E group (P0.05).
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