靶控输注等效剂量的丙泊酚或依托咪酯对患者血液动力学的影响

摘要

Objective The purpose of this study is to explore the evidence for the suitability of different general anesthesia inductions in clinic. The evidences are obtained by the observation of the effects on hemodynamic parameters using target controlled infusion(TCI)anesthesia with propofol and etomidate. Methods 60 patients under general anaesthesia were enrolled, ASA ⅠorⅡ, aged 20-60 years old, who were divide into 2 groups, group P number of 30, group E number of 30. Use propofol TCI on patients in group P(blood target density 2μg/mL). For patients in group E, use etomidate TCI with blood target density 0.3μg/mL. First record the original index from two groups before TCI as T0, and then record HR,MAP,CO,SV,SVR index from two groups at 1 min(T1), 3 min(T2), 7 min (T3), 10 min(T4)after TCI. Results Compared to T0, HR and MAP were signiifcantly decreased after the anesthesia induction for patients in group P(P<0.05), HR and MAP were decreased after the anesthesia induction for patients in group, but no statistically signiifcant difference. Compared to group E, HR and MAP were significantly decreased at T3 and T4(P<0.05). Compared to group E, the changes on CO,SV and SVR have statistically signiifcant difference for patients in group P at T3 and T4, and CO,SV and SVR in group P were inferior to those parameters in group E(P<0.05). Conclusion Effects of equivalent-dose propofol anesthesia induction by target-controlled infusion has more stable hemodynamic than TCI etomidate. Application etomidate for anesthesia induction has litter effects on the cardiovascular and was more suitable for surgery under general anesthesia.%目的：通过观察靶控输注等效剂量的丙泊酚或依托咪酯对患者血液动力学的影响，了解各药物的临床效应，为临床麻醉合理用药提供依据。方法择期全麻下行外科手术患者60例，ASAⅠ~Ⅱ级，年龄（20~60）岁，分为丙泊酚组（P组，n=30），依托咪酯组（E组， n=30）。麻醉诱导前分别靶控输注两种药物，两组患者药物浓度为靶控输注等效剂量下的血药浓度。P组丙泊酚血浆靶浓度为2μg/mL， E组依托咪酯血浆靶浓度为0.3μg/mL。记录诱导前两组基础值（T0），输注后1min（T1）、3min（T2）、7min（T3）、10min（T4）时的HR、MAP、CO、SV、SVR。结果与T0比较，P组患者在靶控输注后HR、MAP明显降低（P<0.05），E组患者在靶控输注后HR、MAP有所降低，但差异无统计学意义；P组较E组在T3、T4时HR、MAP降低明显（P<0.05）；在T3、T4时，P组CO、SV、SVR与E组相比差异有统计学意义，且P组CO、SV、SVR总体趋势明显低于E组（P<0.05）。结论靶控输注依托咪酯用于全麻诱导对血液动力学的影响较丙泊酚轻微，麻醉诱导使用依托咪酯能够起到稳定心血管系统功能和降低麻醉危险性的效果。