阻塞性黄疸患者对吸入麻醉药的敏感性和血流动力学稳定性

发布时间：2018-10-18 10:57

【摘要】：目的比较行肝胆外科手术的高胆红素血症和胆红素正常患者对吸入麻醉药的敏感性,以及血流动力学稳定性。方法收集在异氟烷麻醉下行肝胆外科手术的阻塞性黄疸(黄疸组)和无阻塞性黄疸(对照组)患者各24例。静脉注射1.5~2mg/kg丙泊酚、2μg/kg瑞芬太尼行麻醉诱导,气管插管后控制异氟烷和氧气混合气体流量,维持脑电双频指数(BIS)为46~54。静脉注射麻黄碱、阿托品和瑞芬太尼维持血流动力学指标在基线水平上下30%以内波动。在气管插管前(T0)、麻醉诱导后1min(T1)、气管插管后1和5min(T2、T3)、切皮后1和5min(T4、T5)、门静脉阻断后1和5min(T6、T7)、门静脉开放后1和5min(T8、T9)、拔除气管导管后1和5min(T10、T11)各时间点,记录患者的平均动脉压(MAP)、心率(HR),以及停用异氟烷至自主呼吸恢复的时间、拔除气管导管时间、对刺激睁眼反应的时间(睁眼时间)和呼气末异氟烷体积分数。结果两组间一般资料的差异均无统计学意义(P值均0.05)。黄疸组异氟烷每分钟消耗量、呼气末异氟烷体积分数、瑞芬太尼消耗量均显著低于对照组(P值均0.05),乳酸钠林格注射液、麻黄碱、阿托品用量均显著多于对照组(P值均0.05)。黄疸组恢复自主呼吸时间、拔除气管导管时间、睁眼时间均显著长于对照组(P值均0.05)。黄疸组在T2、T10、T11时间点的MAP均显著低于对照组同时间点(P值均0.05),在T4、T10时间点的HR均显著慢于对照组同时间点(P值均0.05)。结论阻塞性黄疸患者对异氟烷的敏感性增强,麻醉诱导和维持中更易出现低血压和心动过缓,且麻醉恢复时间和拔除气管导管时间延长。
[Abstract]:Objective to compare the sensitivity and hemodynamic stability of hyperbilirubinemia and normal bilirubin in patients undergoing hepatobiliary surgery. Methods 24 patients with obstructive jaundice (jaundice group) and 24 patients without obstructive jaundice (control group) undergoing hepatobiliary surgery under isoflurane anesthesia were collected. Intravenous injection of 1.5~2mg/kg propofol, 2 渭 g/kg remifentanil anesthesia induction, tracheal intubation to control the flow of isoflurane and oxygen mixture gas flow, maintain EEG bispectral index (BIS) of 46V 54. Intravenous ephedrine, atropine and remifentanil maintained hemodynamic indices below 30% above the baseline level. Before endotracheal intubation (T0), 1min (T1) after anesthesia induction, 1 and 5min (T2T3) after tracheal intubation, 1 and 5min (T4T5) after skin incision, 1 and 5min (T6T7) after portal vein occlusion, 1 and 5min (T8T9) after portal vein opening, 1 and 5min (T10T11) after extubation. The mean arterial pressure (MAP),) heart rate (HR), the time of stopping isoflurane from isoflurane to spontaneous respiratory recovery, the time of extubation, the time of eye opening and the volume fraction of end-expiratory isoflurane were recorded. Results there was no significant difference in general data between the two groups (P 0.05). The consumption of isoflurane, end-expiratory isoflurane volume fraction and remifentanil in jaundice group were significantly lower than those in control group (P < 0.05). The dosage of sodium lactate Ringer injection, ephedrine and atropine in jaundice group was significantly higher than that in control group (P < 0.05). In jaundice group, the time of spontaneous respiration, extubation of trachea catheter and eye opening time were significantly longer than those in control group (P < 0.05). The MAP of jaundice group at T2T10 T11 time point was significantly lower than that of control group at the same time point (P all 0. 05), and the HR at T4 T10 time point was significantly slower than that in control group at the same time point (P < 0. 05). Conclusion the sensitivity of patients with obstructive jaundice to isoflurane is enhanced, hypotension and bradycardia are more likely to occur in induction and maintenance of anesthesia, and the time of anesthesia recovery and extubation of trachea catheter is prolonged.
【作者单位】：上海交通大学医学院附属仁济医院麻醉科;
【分类号】：R614

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