异丙酚靶控输注用于心内直视手术快通道麻醉的临床应用

目的研究异丙酚靶控输注用于心内直视手术快通道麻醉的临床应用。方法 60例择期行心内直视手术患者,年龄20～50岁,ASAⅠ～Ⅱ级,心功能Ⅰ～Ⅲ级,左室射血分数（EF）〉50%,无重要系统合并症,无或轻度肺动脉高压,将患者随机均分为A、B两组,每组30例,A组采用靶控输注（TCI）异丙酚麻醉,B组采用恒速输注异丙酚麻醉,手术结束时记录两组患者在麻醉诱导、气管插管、切皮、胸骨纵断、CPB前、CPB后、关胸时心率（HR）、收缩压（SBP）、舒张压（DBP）、平均压（MAP）的变化,记录完全苏醒时间、术后拔除气管插管时间及术后不良反应发生情况。结果 A组患者在气管插管、切皮、胸骨纵断、CPB前及CPB后与B组患者比较,心率较慢,收缩压、舒张压及平均血压较低,即A组患者的生命体征较B组稳定;A组患者的术后苏醒时间及术后拔管时间均比B组患者的为短;A组患者术后不良反应发生率明显低于B组,差异均有统计学意义（p〈0.05）。结论异丙酚靶控输注用于心内直视手术快通道麻醉,能够有效稳定患者术中血流动力学、缩短苏醒及术后拔管时间、减少术后不良反应发生率,是心内直视手术快通道较好的麻醉方式。

APPLICATION OF PROPOFOL GIVEN BY TARGET CONTROLLED INFUSION ON FAST TRACKING ANESTHESIA OF OPEN HEART SURGERY

Objective To study the application of propofol given by target controlled infusion on fast tracking anesthesia of open heart surgery. Methods Sixty patients, age from 20 to 50, ASA I - II, cardiac function I - III, LVEF 〉 50%, scheduled for selective open heart surgery under general anesthesia were randomly divided into two groups with 30 cases each. Group A and B received TCI of propofol and constant injection of propofol, respectively. Record the variation of HR, SBP, DBP and MAP at induction, intubation, skin incision, sternum broken, befor CPB, after CPB and sternal closure after surgery; Meanwhile, record complete wake up time, extubation time and complica- tions. Results Group A shows slower HR, lower BP at intubation, skin incision, sternum broken, befor CPB and af- ter CPB, compared to group B. The complete wake up time and extubation time of group A are significantly shorter than group B. Complications of group A is lower than group B. Conclusion Application of propofol given by target controlled infusion on fast tracking anesthesia offers stable hemodynamics, shorter wake up time and fewer complica- tions for patients of open heart surgery.