目的 评价儿童静脉注射不同剂量丙泊酚后麻醉深度的变化及其对应激反应和血流动力学的影响.方法 对36例下腹部手术患儿,采用常规全身麻醉(全麻)复合镇痛药和肌松药,将其按丙泊酚维持剂量分为3组(A组:丙泊酚10 mg·kg-1·h-1,每隔20 min按照10、8、6 mg·kg-1·h-1方案减量;B组:丙泊酚15 mg·kg-1·h-1,每隔20 min按15、10、8 mg·kg-1·h-1减量;C组:丙泊酚20 mg·kg-1·h-1,每隔20 min按20、15、10 mg·kg-1·h-1减量),每组12例.在给药后每隔2 min记录1次脑电双频指数(BIS)、心率、血压.在麻醉诱导前(T1)、气管插管前1 min(T2)、气管插管后1 min(T3)、切皮前1 min(T4)、切皮后1 min(T5)、手术探查(T6)及手术结束(T7)时,采血测定血清皮质醇和血糖浓度.在T4、T6、T7时间点测定血清丙泊酚浓度.结果 B、C组镇静深度达到手术要求,应激反应较A组轻,但长时间高浓度丙泊酚输注可导致血压下降,心率减慢.结论 儿童全麻使用15 mg·kg-1·h-1丙泊酚,并根据BIS值和血流动力学指标调整维持剂量,可达到满意的麻醉效果和适当的应激水平.%Objective To evaluate the changes in anesthesia depth and effects on stress response, haemodynamics after intravenous injection of different doses of propofol. Methods Routine general anesthesia combined with analgesic and muscle relaxants were conducted on 36 children who would accept lower abdominal surgery,and they were divided into 3 groups with 12 children in each group,according to maintenance dose of propofol (group A; 10 mg · Kg-1 · H-1 propofol,reduction according to scheme of 10, 8,6 mg · Kg-1 · H-1 every 20 min; group B:15 mg · Kg-1 · H-1 propofol, reduction according to scheme of 15,10,8 mg · Kg-1· H-1 every 20 min;group C:20 mg · Kg-1 · H-1 propofol, reduction according to scheme of 20,15,10 mg · Kg-1 · H-1 every 20 min). Bispectral index (BIS) ,heart rate and blood pressure were recorded every 2 min after administration of anesthetic agent. Venous blood samples were collected to detect serum cortisol and blood sugar concentration before anesthesia induction (Tl),l min before endotracheal intubation(T2) ,1 min before skin incision(T4) ,1 min after skin incision (T5) ,during surgical exploration (T6) and at the end of surgery (T7). Serum propofol concentrations were measured at the time point of T4 ,T6 ,T7. Results The depth of sedation of children in group B and C achieved surgical condition and their stress response was milder than that in group A. However, prolonged and high concentration of propofol infusion led to low blood pressure and low heart rate. Conclusion It can achieve satisfactory anesthesia and appropriate stress response using 15 mg · Kg-1 · H-1 propofol for maintenance of general anesthesia and adjusting the dose according with BIS values and hemodynamic parameters in children.
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