CAJ | 학술논문

目的采用Swan-Ganz导管法评价不同剂量舒芬太尼复合低血浆靶浓度丙泊酚麻醉诱导对冠状动脉旁路移植术患者血液动力学的影响.方法择期冠状动脉旁路移植术患者50例,年龄45～64岁,体重指数≤30 kg/m2,性别不限,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,左室射血分数(LVEF)≥50％.采用随机数字表法,将其分为不同剂量舒芬太尼组(S1组和S2组),每组25例.经右颈内静脉穿刺分别放置中心静脉导管及Swan-Ganz导管.麻醉诱导:S1组和S2组分别静脉注射舒芬太尼0.5、1.0 μg/kg,60 s后靶控输注丙泊酚,血浆靶浓度2μg/ml,意识消失时静脉注射罗库溴铵0.8mg/kg,气管插管并行机械通气.分别于麻醉诱导前(T1)、意识消失即刻(T2)、气管插管前即刻(T3)和气管插管后即刻(T4)记录HR、MAP、CVP、肺毛细血管楔压、心指数、外周血管阻力、每搏指数和混合静脉血氧饱和度.记录麻醉诱导期间心血管事件的发生情况.结果与T1时比较,S2组T3时MAP、外周血管阻力降低(P＜0.05),S1组其余时点血流动力学指标差异无统计学意义(P＞0.05);与S1组比较,S2组L时MAP降低,低血压发生率升高(P＜0.05),其余指标差异无统计学意义(P＞0.05).结论对于冠状动脉旁路移植术患者,复合丙泊酚低血浆靶浓度2 μg/ml麻醉诱导时舒芬太尼的适宜剂量为0.5 μμg/kg.
목적 채용Swan-Ganz도관법평개불동제량서분태니복합저혈장파농도병박분마취유도대관상동맥방로이식술환자혈액동역학적영향.방법 택기관상동맥방로이식술환자50례,년령45～64세,체중지수≤30 kg/m2,성별불한,ASA분급Ⅱ혹Ⅲ급,NYHA분급Ⅱ혹Ⅲ급,좌실사혈분수(LVEF)≥50％.채용수궤수자표법,장기분위불동제량서분태니조(S1조화S2조),매조25례.경우경내정맥천자분별방치중심정맥도관급Swan-Ganz도관.마취유도:S1조화S2조분별정맥주사서분태니0.5、1.0 μg/kg,60 s후파공수주병박분,혈장파농도2μg/ml,의식소실시정맥주사라고추안0.8mg/kg,기관삽관병행궤계통기.분별우마취유도전(T1)、의식소실즉각(T2)、기관삽관전즉각(T3)화기관삽관후즉각(T4)기록HR、MAP、CVP、폐모세혈관설압、심지수、외주혈관조력、매박지수화혼합정맥혈양포화도.기록마취유도기간심혈관사건적발생정황.결과 여T1시비교,S2조T3시MAP、외주혈관조력강저(P＜0.05),S1조기여시점혈류동역학지표차이무통계학의의(P＞0.05);여S1조비교,S2조L시MAP강저,저혈압발생솔승고(P＜0.05),기여지표차이무통계학의의(P＞0.05).결론 대우관상동맥방로이식술환자,복합병박분저혈장파농도2 μg/ml마취유도시서분태니적괄의제량위0.5 μμg/kg.
Objective To evalutate the effects of different doses of sufentanil combined with low target plasma concentration of propofol for induction of anesthesia on hemodynamics in patients undergoing coronary artery bypass grafting using Swan-Ganz catheter.Methods Fifty ASA physical status Ⅱ-Ⅲ patients (NYHA Ⅱ or Ⅲ) patients,aged 45-64 yr,with body mass index ≤ 30 kg/m2 and left ventricular ejection fraction (LVEF) ≥ 50 ％,scheduled for elective coronary artery bypass grafting,were randomly assigned into 2 groups (n =25 each) using a random number table:sufentanil 0.5μg/kg group (group S1) and sufentanil 1.0 μg/kg group (group S2).Central venous catheter and Swan-Ganz catheter were all placed via the right jugular vein before induction of anesthesia.Anesthesia was induced with iv injection of sufentanil 0.5 μg/kg (group S1) or 1.0 μg/kg (group S1),and 60 s later propofol was given by target-controlled infusion (target plasma concentraion 2 μg/ml).Rocuronium 0.8 mg/kg was administered when consciousness was lost.The patients were endotracheally intubated and mechanically ventilated.Before induction (T1),immediately after loss of consciousness (T2),immediately before intubation (T3),and immediately after intubation (T4),HR,mean artery pressure monitoring (MAP),central venous pressure (CVP),pulmonary arterial wedge pressure (PAWP),cardiac index (CI),stroke volume index (SVI),systolic vascular resistance and mixed venous oxygen saturation (Sv-O2) were recorded.The development of adverse cardiovascular events was recorded during induction of anesthesia.Results Compared with the baseline value at T1,the MAP and systolic vascular resistance were significantly decreased at T3 in group S2 (P ＜ 0.05),and no significant changes were found in the parameters of hemodynamics at T2-4 in group S1 (P ＞ 0.05).Compared with group S1,the MAP was significantly decreased at T3 and the incidence of hypotension was increased in group S2 (P ＜ 0.05).Conclusion For the patients undergoing coronary artery bypass grafting,the optimum dose of sufentanil for induction of anesthesia is 0.5 μg/kg when combined with low target plasma concentration of propofol.