硫酸镁对气管插管时血流动力学和应激激素浓度的影响

目的:以脑电双频指数(BIS)作为麻醉深度监测指标,研究靶控输注丙泊酚时不同剂量的硫酸镁对气管插管时血流动力学和应激激素浓度变化的影响,以及对丙泊酚效应室靶浓度的影响。方法:60例择期手术病人随机分为C组、M1组和M2组,每组20例。以靶控输注丙泊酚行麻醉诱导(初始靶浓度为2μg/mL),M1组和M2组在气管插管前3min分别静脉推注硫酸镁15、25mg/kg;并根据BIS值变化调节3组丙泊酚靶浓度,使BIS值在45～55范围内。结果:C组的SBP、MBP在插管后即刻和1min较基础值明显升高(P0.01),M1、M2组变化不明显(P0.05)。C组血浆Cor浓度在插管后3min时明显上升(P0.05),而M1、M2组呈下降趋势(P0.05)。C组血浆A-Ⅱ浓度在插管后3、10min时明显上升(P0.05),与M1组、M2组相比差异显著(P0.05)。C组在插管后5、10min丙泊酚靶有效浓度显著高于M1组和M2组(P0.01);M2组在同一时点低于M1组(PO.O5)。结论:与15mg/kg硫酸镁组相比,25mg/kg硫酸镁组能更好地减轻气管插管引起的应激反应,并且明显降低丙泊酚TCI效应室靶浓度,减少丙泊酚用量。

Effects of Magnesium Sulfate Infusion on Hemodynamics and Stress Hormone Concentrations during Endotracheal Intubation

Objective To investigate the effects of magnesium sulfate and propofol by target-controlled infusion （TCI） for relieving the hemodynamics change and stress response to endotracheal intubation, when the depth of anesthesia was maintained at BIS 45～55 and to investigate the effect of magnesium sulfate on effective-site concentration of propofol by TCI. Methods Sixty ASA-II patients undergoing elective surgery were randomly divided into three groups with 20 patients in each group： group C was given propofol, group M1 propofol＋low-dose magnesium sulfate, Group M2 propofol＋high-dose magnesium sulfate. The initial target effective-site concentration of propofol was set at 2.0 μg/mL during induction. The patients in group M1 or group M2 were given magnesium sulfate in a dose of 15 or 25 mg/kg bolus, 3 minutes before endotracheal intubation. BIS value was maintained at 45-55 by modifying target effect-site concentration of propofol. Results SBP, DBP of group M1 and M2 did not statistically increase at the moment and 1 minute after intubation （P〈0.05）, but index of group C increased significantly （P〈0.01）. The plasma concentration of cortisol increased significantly 3 min after intubation （P〈0.05）, the level of cortisol declined in group M1 and M2, being of significant difference with group C （P〈0.05）. The concentration of A-II increased significantly 3、10 minutes after intubation （P〈0.05）. It was significantly lower in group M1 （P〈0.05） and group M2 （P〈0.01） than that in group C. Comparing group C, the effect-site concentration of propofol was decreased at 5、10 minutes after intubation in group M1 and M2 （P〈0.01）. It was significantly lower in group M2 than that in group M1 （P〈0.05）. Conclusion Comparing with 15 mg/kg magnesium sulfate, 25 mg/kg magnesium sulfate effectively inhibits the stress response to endotracheal intubation, and reduces the target effect-site concentration of propofol.