CAJ | 학술논문

目的选择对咪达唑仑-芬太尼-依托咪酯全麻诱导时影响诱导期插管前血流动力学变化的多种因素进行多元分析.方法 ASA Ⅰ～Ⅱ级,年龄17 ～ 62岁的全麻患者317例.固定维库溴铵用量,不同途径(右颈内静脉、前臂静脉、大隐静脉)、不同剂量的咪达唑仑、芬太尼,不同剂量和注速的依托咪酯顺序静脉诱导.插管前平均动脉压(MAP)平均值与基础MAP变化率[MAP％=(MAP - MAPT0)/MAP10×100％]作为麻醉诱导后插管前血流动力学波动的指标.用多元逐步回归与相关分析多种因素[性别(x1),年龄(x2),身高(x3),体质量(x4),是否合并高血压病(x5),咪达唑仑用量(x6),芬太尼用量(x7),依托咪酯用量(x8),注药速度(x9)和注药途径(x10)]对麻醉诱导期插管前MAP％的影响,通过标准化偏回归系数比较各影响因素对MAP％的相对重要性.结果多元逐步回归分析选入、剔除水平取0.1～0.2时,10个研究因素中年龄、注药速度、注药途径、芬太尼用量和依托咪酯用量5个因素进入最优线性回归方程,且由大到小依次影响着MAP％(标准偏回归系数分别为- 0.3061、-0.2374、-0.2165、- 0.1795、- 0.0921).一般回归方程为MAP％=- 0.2687x2(y) - 2.5901x7(μg/kg) -8.7569x9mg/s +4.4985x10 - 13.2671x8mg/kg +5.4323(F=9.32,P＜0.01,修正R2为0.7927).结论本研究条件下,影响插管前血压波动的主要因素由大到小依次为年龄、依托咪酯注药速度、注药途径、芬太尼用量和依托咪酯用量.尽管一般认为依托咪酯麻醉的优点是对血流动力学影响轻微,但在联合应用咪达唑仑、芬太尼和维库溴铵静脉诱导时,仍要考虑到有许多因素影响着诱导期血流动力学稳定性.
목적 선택대미체서륜-분태니-의탁미지전마유도시영향유도기삽관전혈류동역학변화적다충인소진행다원분석.방법 ASA Ⅰ～Ⅱ급,년령17 ～ 62세적전마환자317례.고정유고추안용량,불동도경(우경내정맥、전비정맥、대은정맥)、불동제량적미체서륜、분태니,불동제량화주속적의탁미지순서정맥유도.삽관전평균동맥압(MAP)평균치여기출MAP변화솔[MAP％=(MAP - MAPT0)/MAP10×100％]작위마취유도후삽관전혈류동역학파동적지표.용다원축보회귀여상관분석다충인소[성별(x1),년령(x2),신고(x3),체질량(x4),시부합병고혈압병(x5),미체서륜용량(x6),분태니용량(x7),의탁미지용량(x8),주약속도(x9)화주약도경(x10)]대마취유도기삽관전MAP％적영향,통과표준화편회귀계수비교각영향인소대MAP％적상대중요성.결과 다원축보회귀분석선입、척제수평취0.1～0.2시,10개연구인소중년령、주약속도、주약도경、분태니용량화의탁미지용량5개인소진입최우선성회귀방정,차유대도소의차영향착MAP％(표준편회귀계수분별위- 0.3061、-0.2374、-0.2165、- 0.1795、- 0.0921).일반회귀방정위MAP％=- 0.2687x2(y) - 2.5901x7(μg/kg) -8.7569x9mg/s +4.4985x10 - 13.2671x8mg/kg +5.4323(F=9.32,P＜0.01,수정R2위0.7927).결론 본연구조건하,영향삽관전혈압파동적주요인소유대도소의차위년령、의탁미지주약속도、주약도경、분태니용량화의탁미지용량.진관일반인위의탁미지마취적우점시대혈류동역학영향경미,단재연합응용미체서륜、분태니화유고추안정맥유도시,잉요고필도유허다인소영향착유도기혈류동역학은정성.
Objective To analyze the many factors of hemodynamic changes before intubation during anesthetic induction with midazolam,fentanyl and etomidate.Methods Three hundred and seventeen patients (ASA Ⅰ - Ⅱ,aged 17 -62 years) underwent general anesthesia were studied.Before vecuronium was given,different doses of midazolam and fentanyl were administered.Then different doses and injection speed of etomidate was given.All of the drugs were administered through different channels (right internal jugular vein,forearm vein or saphenous vein).The index of the research was MAP％ [ the percentage of change between the average MAP before intubation and based MAP:MAP％ =( MAP - MAPT0) /MAPT0 × 100％ ].Multiple linear stepwise regression and correlation analysis models were used to analyze the influence between many factors [ sex( x1 ),age(x2),height( x3 ),total body weight ( x4 ),combined with hypertension or not( x5 ),dose of midazol ( x6 ),fentanyl ( x7 ) and etomidate( x8),the rates ( x9 ) and the approach (x10) of etomidate injection] and MAP％.The influence of the factors in the ＂ best＂ regression models was judged by standardized partial regression coefficients.Results Only the factors of age,the rates of etomidate injection and the approach,dose of fentanyl and etomidate were independently associated with MAP％ when all variables were included in a multiple regression model when slentry (α) and slstay level(β) =0.10.Standardized partial regression coefficient of these factors before intubation were - 0.3061,- 0.2374,- 0.2165,- 0.1795 and - 0.0921,respectively.Regression Equation was MAP％ =- 0.2687x2 (y) - 2.5901x7 (μg/kg) - 8.7569x9 (mg/s) +4.4985x10 - 13.2671x8 (mg/kg) + 5.4323 (F =9.32,P ＜ 0.01.The R 2 of correction was 0.7927).Conclusions In the present study,the factors of effect on the blood pressure before intubation in descending order are age,the rates of etomidate injection and the approach,dose of fentanyl and etomidate.Although etomidate anesthesia had the advantage of the little effect on hemodynamics,there are many factors which affected the hemodynamic stability during intravenous induction in sequence of midazolam,fentanyl,etomidate and vecuronium.