异丙酚Graseby3500与TCI-Ⅰ靶控输注时对患者血流动力学的影响

摘要

Objective To compare haemodynamics variations of different target-controlled infusion (TCI) systems between Graseby3500 and TCI- Ⅰ applied in patients. Method 30 ASA Ⅰ - I1 patients undergoing polyp of cord ectomy under pedestal laryngoscope were studied. 30 patients were randomly allocated to two groups including A group (Graseby3500) And B group(TCI- l ). Lactated Ringers solution as consistent with 10ml/kg · hour was infused within 30 min before TCI. The propofol plasma concentration of TCI was set at 3μg/ml and infusion time last 20min. I rin after TCI, the patients were infused midazolam 0. 08mg/kg, fentanyl 5μg/kg and succinylcholine lmg/kg to facilitate tracheal incubation. If HR was lower than 55/min or NBP was lower than 60/30mmHg,atropine 0. 25mg or ephedrine 6mg was infused respectively. SBP, DBP, MBP, HR, etCO2, and armpit-temperature were continuously monitored and recorded during TCI and 20 minutes after TCL Results At the time of 2. 5, 5, 7.5 and 10min after target-controlled infusion, HR in A group was obviously lower(than that in B groupP＜0. 035). No difference was found between two groups about SBP, DBP, MBP, et CO2, and armpit-temperature. Conclusion TCI- I system exhibited less influence on HR during early TCI than Graseby 3500 system. Certain degree of volume support may play a positive role in the stability of blood pressure prior to TCL.%目的 比较不同靶控输注系统Graseby3500与TCI-Ⅰ对患者血流动力学的影响.方法 选择30例ASAⅠ～Ⅱ级并符合纳入标准的支撑喉镜下声带息肉切除术病人,随机均分为2组,A组:Graseby3500;B组:TCI-Ⅰ.入室后行肘静脉穿刺王管建立静脉通道,在30min内输入10ml/kg复方乳酸林格氏液生理需要量后,选用阿斯利康Propofol Injection(Diprivan)50ml行靶控输注,血浆药物浓度设为3μg/ml,靶控开始后1分钟静注咪唑安定0.08mg/kg,芬太尼5μg/kg,司可林1mg/kg诱导插管,靶控输注20分钟.记录靶控开始及靶控停止后2.5、5、7.5、10、15、20min时的心率、呼末CO2分压、无创血压、手术时间,阿托品及麻黄素的使用例数,靶控期间输液量、手术出血量及腋温.结果 两组患者的手术时问、异丙酚总用量、阿托品及麻黄素使用例数、靶控期间输液量及手术出血量无统计学差异(P>0.05).靶控输注前两组患者心率、血压、呼末CO2分压无差异(P>0.05);靶控开始后2.5、5、7.5、10min时A组心率明显低于B组(P<0.035),血压、呼末CO2分压无差异(P>0.05);靶控开始后15、20min及靶控停止后2.5、5、7.5、10、15、20min心率、呼末CO2分压及无创血压无明显差异.结论 国产异丙酚TCI-Ⅰ靶控输注系统较Graseby3500系统对患者靶控输注早期心率影响较小,有可能是二者实际血浆药物浓度差异造成.靶控输注前一定的容量支持对血压的稳定有着积极的作用.