国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
3期
164-168
,共5页
全立新%李坚%倪东妹%王东信
全立新%李堅%倪東妹%王東信
전립신%리견%예동매%왕동신
高血压%麻醉%气管内插管%心血管反应%右美托咪啶
高血壓%痳醉%氣管內插管%心血管反應%右美託咪啶
고혈압%마취%기관내삽관%심혈관반응%우미탁미정
Hypertension%Anesthesia%Endotracheal intubation%Cardiovascular response%Dexmedetomidine
目的 评估右美托咪啶对高血压患者在麻醉诱导和气管插管期间心血管反应的影响. 方法 采用前瞻性、双盲、随机对照研究设计.选择术前合并高血压病并接受规范抗高血压治疗的患者按随机数字法分为右美托咪啶组(D组)和对照组(C组),诱导前分别静脉输注右美托咪啶(初始量1.0 μg/kg,输注10 min,继以0.7 μg· kg-1·h1输注15 min)或等量生理盐水.麻醉诱导均采用舒芬太尼、丙泊酚和罗库溴铵,维持脑电双频谱指数(bispectral index,BIS)值40～60.记录患者在试验药物给药前、后和麻醉诱导期间的收缩压(SBP)、舒张压(DBP)和血压变化.结果 给予右美托咪啶后治疗组的SBP和心率(HR)较对照组明显降低[分别为(139.1±23.9) mm Hg(1 mm Hg=0.133 kPa)比(165.2±18.3) mm Hg,P＜0.001和(63.8±11.3)次/min比(77.2±13.0)次/min,P=0.001].麻醉诱导后喉镜暴露前治疗组的SBP、DBP下降幅度明显低于对照组[分别为(-14.6±9.6)％比(-34.5±10.7)％,P＜0.001和(-7.2±9.6)％比(-28.7±12.0)％,P＜0.001 ].气管插管后1 min时治疗组的SBP、DBP和HR均明显低于对照组[分别为SBP(134.0±25.8) mm Hg比(171.6±30.0) mm Hg,P＜0.001；DBP(78.1±17.7) mm Hg比(93.3±17.5) mm Hg,P=0.009; HR(71.1±11.0)次/min比(9t.1±14.0)次min,P＜0.001].结论 右美托咪啶复合丙泊酚、舒芬太尼能减弱高血压患者在麻醉诱导期间的血压下降,并能抑制气管插管所引起的心血管反应.
目的 評估右美託咪啶對高血壓患者在痳醉誘導和氣管插管期間心血管反應的影響. 方法 採用前瞻性、雙盲、隨機對照研究設計.選擇術前閤併高血壓病併接受規範抗高血壓治療的患者按隨機數字法分為右美託咪啶組(D組)和對照組(C組),誘導前分彆靜脈輸註右美託咪啶(初始量1.0 μg/kg,輸註10 min,繼以0.7 μg· kg-1·h1輸註15 min)或等量生理鹽水.痳醉誘導均採用舒芬太尼、丙泊酚和囉庫溴銨,維持腦電雙頻譜指數(bispectral index,BIS)值40～60.記錄患者在試驗藥物給藥前、後和痳醉誘導期間的收縮壓(SBP)、舒張壓(DBP)和血壓變化.結果 給予右美託咪啶後治療組的SBP和心率(HR)較對照組明顯降低[分彆為(139.1±23.9) mm Hg(1 mm Hg=0.133 kPa)比(165.2±18.3) mm Hg,P＜0.001和(63.8±11.3)次/min比(77.2±13.0)次/min,P=0.001].痳醉誘導後喉鏡暴露前治療組的SBP、DBP下降幅度明顯低于對照組[分彆為(-14.6±9.6)％比(-34.5±10.7)％,P＜0.001和(-7.2±9.6)％比(-28.7±12.0)％,P＜0.001 ].氣管插管後1 min時治療組的SBP、DBP和HR均明顯低于對照組[分彆為SBP(134.0±25.8) mm Hg比(171.6±30.0) mm Hg,P＜0.001；DBP(78.1±17.7) mm Hg比(93.3±17.5) mm Hg,P=0.009; HR(71.1±11.0)次/min比(9t.1±14.0)次min,P＜0.001].結論 右美託咪啶複閤丙泊酚、舒芬太尼能減弱高血壓患者在痳醉誘導期間的血壓下降,併能抑製氣管插管所引起的心血管反應.
목적 평고우미탁미정대고혈압환자재마취유도화기관삽관기간심혈관반응적영향. 방법 채용전첨성、쌍맹、수궤대조연구설계.선택술전합병고혈압병병접수규범항고혈압치료적환자안수궤수자법분위우미탁미정조(D조)화대조조(C조),유도전분별정맥수주우미탁미정(초시량1.0 μg/kg,수주10 min,계이0.7 μg· kg-1·h1수주15 min)혹등량생리염수.마취유도균채용서분태니、병박분화라고추안,유지뇌전쌍빈보지수(bispectral index,BIS)치40～60.기록환자재시험약물급약전、후화마취유도기간적수축압(SBP)、서장압(DBP)화혈압변화.결과 급여우미탁미정후치료조적SBP화심솔(HR)교대조조명현강저[분별위(139.1±23.9) mm Hg(1 mm Hg=0.133 kPa)비(165.2±18.3) mm Hg,P＜0.001화(63.8±11.3)차/min비(77.2±13.0)차/min,P=0.001].마취유도후후경폭로전치료조적SBP、DBP하강폭도명현저우대조조[분별위(-14.6±9.6)％비(-34.5±10.7)％,P＜0.001화(-7.2±9.6)％비(-28.7±12.0)％,P＜0.001 ].기관삽관후1 min시치료조적SBP、DBP화HR균명현저우대조조[분별위SBP(134.0±25.8) mm Hg비(171.6±30.0) mm Hg,P＜0.001；DBP(78.1±17.7) mm Hg비(93.3±17.5) mm Hg,P=0.009; HR(71.1±11.0)차/min비(9t.1±14.0)차min,P＜0.001].결론 우미탁미정복합병박분、서분태니능감약고혈압환자재마취유도기간적혈압하강,병능억제기관삽관소인기적심혈관반응.
Objective To evaluate the effects of dexmedetomidine on cardiovascular responses during anesthetic induction and endotracheal intubation in hypertensive patients. Methods This was a prospective,double-blind,and placebo controlled study. Patients with preoperative diagnosed and well controlled hypertension were enrolled and randomly divided into dexmedetomidine group (group D) and control group (group C).Dexmedetomidine (an initial dose of 1.0 μg/kg within 10 min,followed by a continuous infusion of 0.7 μg·kg-1 ·h-1 for 15 min) or normal saline was administered 25 minutes before anesthetic induction.Anesthesia was induced with sufentanil,propofol,and rocuronium.Bispectral index was maintained between 40 to 60.Hemodynamic parameters including systolic (SBP) and diastolic blood pressures (DBP),and heart rate (HR) were recorded and the changes were calculated during both anesthetic induction and intubation. Results After administration of dexmedetomidine,SBP and HR were significantly lower in the treatment group than that in the control group [ (139.1 ±23.9) mm Hg vs.(165.2±1 8.3)mm Hg,P＜0.001 and (63.8±11.3) bpm vs. (77.2±13.0) bpm,P=0.001,respectively].Before insertion of the laryngoscope,the percentage decreased in SBP and DBP were significantly less in the treatment group than that in the control group[(-14.6±9.6)％vs.(-34.5±10.7)％,P＜0.001 and (-7.2±9.6)％ vs.(-28.7±12.0)％,P＜0.001,respectively].One minute after endotracheal intubation,SBP,DBP,and HR were significantly lower in the treatment group than that in the control group [SBP:(134.0±25.8) mm Hg vs.(171.6 ± 30.0) mm Hg,P＜0.001; DBP:(78.1±17.7) mm Hg vs.(93.3±17.5) mm Hg,P=0.009; and HR:(71.1±11.0) bpm vs.(91.1± 14.0) bpm,P＜0.001,respectively]. Conclusions Dexmedetomidine combined with propofol and sufentanil suppressed the decrease in blood pressure due to anesthetic induction and blunted the cardiovascular responses to endotracheal intubation in hypertensive patients.
