中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
15期
9-11
,共3页
二异丙酚%导管插入术,外周%瑞芬太尼%麻醉诱导%心血管反应
二異丙酚%導管插入術,外週%瑞芬太尼%痳醉誘導%心血管反應
이이병분%도관삽입술,외주%서분태니%마취유도%심혈관반응
Propofol%Catheterization,peripheral%Remifentanil%Anesthesia induction%Cardiovascular responses
目的 观察普鲁泊福麻醉诱导时复合不同剂量瑞芬太尼应用于非肌松剂气管插管时对患者心血管反应的影响.方法 将60例ASA分级Ⅰ～Ⅱ级的非心、脑外科择期全身麻醉手术患者按随机数字表法分为Ⅰ、Ⅱ、Ⅲ组,每组20例,注射泵输注瑞芬太尼血浆靶控浓度分别为2、3、4ng/ml,输注5 min后开始靶控输注普鲁泊福(血浆靶控浓度3μg/ml).记录三组患者诱导前(T1)、普鲁泊福开始即刻(T2)、气管插管前即刻(T3)、气管插管后1 min(T4)的平均动脉压(MAP)、心率变化,以及气管插管评分和第1次插管成功率.结果 Ⅰ、Ⅱ、Ⅲ组气管插管评分分别为(10.5±2.9)、(7.6±2.3)、(5.8±1.2)分,第1次插管成功率分别为50%(10/20)、80%(16/20)、100%(20/20),三组间比较差异均有统计学意义,Ⅲ组均优于Ⅰ组和Ⅱ组(P＜0.05).T2与T1比较,Ⅱ组和Ⅲ组心率均显著减慢(P＜0.05),Ⅲ组更明显;T4与T3比较,Ⅰ组和Ⅱ组心率显著增快,Ⅰ组明显高于Ⅱ组和Ⅲ组(P＜0.05).T3与T2比较,三组MAP均显著下降;T4与T3比较,Ⅰ组MAP显著上升,且高于Ⅱ组和Ⅲ组(P＜0.05).结论 在不使用肌松剂时,普鲁泊福复合瑞芬太尼靶控浓度3～4 ng/ml能较好地抑制气管插管的应激反应,而又不引起明显的循环抑制,对维持麻醉诱导插管过程的平稳较为有利.
目的 觀察普魯泊福痳醉誘導時複閤不同劑量瑞芬太尼應用于非肌鬆劑氣管插管時對患者心血管反應的影響.方法 將60例ASA分級Ⅰ～Ⅱ級的非心、腦外科擇期全身痳醉手術患者按隨機數字錶法分為Ⅰ、Ⅱ、Ⅲ組,每組20例,註射泵輸註瑞芬太尼血漿靶控濃度分彆為2、3、4ng/ml,輸註5 min後開始靶控輸註普魯泊福(血漿靶控濃度3μg/ml).記錄三組患者誘導前(T1)、普魯泊福開始即刻(T2)、氣管插管前即刻(T3)、氣管插管後1 min(T4)的平均動脈壓(MAP)、心率變化,以及氣管插管評分和第1次插管成功率.結果 Ⅰ、Ⅱ、Ⅲ組氣管插管評分分彆為(10.5±2.9)、(7.6±2.3)、(5.8±1.2)分,第1次插管成功率分彆為50%(10/20)、80%(16/20)、100%(20/20),三組間比較差異均有統計學意義,Ⅲ組均優于Ⅰ組和Ⅱ組(P＜0.05).T2與T1比較,Ⅱ組和Ⅲ組心率均顯著減慢(P＜0.05),Ⅲ組更明顯;T4與T3比較,Ⅰ組和Ⅱ組心率顯著增快,Ⅰ組明顯高于Ⅱ組和Ⅲ組(P＜0.05).T3與T2比較,三組MAP均顯著下降;T4與T3比較,Ⅰ組MAP顯著上升,且高于Ⅱ組和Ⅲ組(P＜0.05).結論 在不使用肌鬆劑時,普魯泊福複閤瑞芬太尼靶控濃度3～4 ng/ml能較好地抑製氣管插管的應激反應,而又不引起明顯的循環抑製,對維持痳醉誘導插管過程的平穩較為有利.
목적 관찰보로박복마취유도시복합불동제량서분태니응용우비기송제기관삽관시대환자심혈관반응적영향.방법 장60례ASA분급Ⅰ～Ⅱ급적비심、뇌외과택기전신마취수술환자안수궤수자표법분위Ⅰ、Ⅱ、Ⅲ조,매조20례,주사빙수주서분태니혈장파공농도분별위2、3、4ng/ml,수주5 min후개시파공수주보로박복(혈장파공농도3μg/ml).기록삼조환자유도전(T1)、보로박복개시즉각(T2)、기관삽관전즉각(T3)、기관삽관후1 min(T4)적평균동맥압(MAP)、심솔변화,이급기관삽관평분화제1차삽관성공솔.결과 Ⅰ、Ⅱ、Ⅲ조기관삽관평분분별위(10.5±2.9)、(7.6±2.3)、(5.8±1.2)분,제1차삽관성공솔분별위50%(10/20)、80%(16/20)、100%(20/20),삼조간비교차이균유통계학의의,Ⅲ조균우우Ⅰ조화Ⅱ조(P＜0.05).T2여T1비교,Ⅱ조화Ⅲ조심솔균현저감만(P＜0.05),Ⅲ조경명현;T4여T3비교,Ⅰ조화Ⅱ조심솔현저증쾌,Ⅰ조명현고우Ⅱ조화Ⅲ조(P＜0.05).T3여T2비교,삼조MAP균현저하강;T4여T3비교,Ⅰ조MAP현저상승,차고우Ⅱ조화Ⅲ조(P＜0.05).결론 재불사용기송제시,보로박복복합서분태니파공농도3～4 ng/ml능교호지억제기관삽관적응격반응,이우불인기명현적순배억제,대유지마취유도삽관과정적평은교위유리.
Objective To observe the impacts on the patients with cardiovascular responses when applying propofol combined with different dose of remifentanil in tracheal intubation without the use of muscle relaxants for anesthesia induction. Methods Sixty patients undergoing selective general anesthesia operation of ASA Ⅰ -Ⅱ non-heart and brain surgery were divided into three groups by random digits table, and 20 cases for each group. Target-controlled infusion of remifentanil with respective plasma concentration of 2 ng/ml (group Ⅰ ), 3 ng/ml (group Ⅱ ) and 4 ng/ml (group Ⅲ). Target-controlled infusion of propofol after infusion of remifentanil for 5 min (3 μg/ml of plasma target concentration). The mean arterial pressure (MAP),heart rate (HR), intubation conditions and success rate of patients in different groups before induction(T1), at the beginning moment of propofol(T2),at the immediate moment before tracheal intubation (T3) and at the time of 1 min after tracheal intubation (T4). Results The grade of tracheal intubation was (10.5 ±2.9), (7.6 ±2.3), (5.8 ± 1.2) scores and the success rate of the first intubation was 50%( 10/20), 80%(16/20), 100%(20/20) in group Ⅰ ,Ⅱ and Ⅲ , there were significant differences among three groups (P＜ 0.05),group Ⅲ was superior to group Ⅰ and Ⅱ (P＜0.05). Comparing T2 and Tj,HR in group Ⅱ and Ⅲ slowed down significantly ( P ＜ 0.05), and in group Ⅲ slowed down more significantly (P＜0.05). Comparing T4 and T3,HR in group Ⅰ and Ⅱ quickened significantly, and group Ⅰ was higher than group Ⅱ and Ⅲ (P＜ 0.05). Comparing T3 and T2,MAP decreased significantly among three groups,comparing T4 and T3, MAP increased significantly in group Ⅰ which was higher than that in group Ⅱ and Ⅲ (P ＜ 0.05). Conclusions Without the use of muscle relaxants, propofol combined with remifentanil for 3-4 ng/ml can better restrain the tracheal intubation stress responses and won't cause significant cycle inhibition. They benefit to maintain the smooth intubation process of anesthesia induction.
