四种常用全麻诱导插管方法对血流动力学的影响

目的观察对比依托咪酯、咪唑安定、异丙酚与咪唑安定联合异丙酚全身麻醉快速诱导对气管插管血流动力学的影响。方法选择ASA I~Ⅱ级需行气管插管全麻的病人60例,随机分为四组(n=15):依托咪酯组(A组)、咪唑安定组(B组)、异丙酚组(C组)与咪唑安定-异丙酚(D组)。麻醉诱导:静脉全麻药A组依托咪酯0.3 mg/kg、B组咪唑安定0.3 mg/kg、C组异丙酚2 mg/kg与D组咪唑安定1 mg/kg+异丙酚1 mg/kg,合用药物均为芬太尼3μg/kg和维库溴铵0.1 mg/kg,诱导后5 min行气管插管。监测记录麻醉前后各时点的BP、HR,观察有无不良反应。结果诱导后各组BP、HR均有下不同程度下降,B、C组BP、HR变化最大,与诱导前比差异有显著性意义(p<0.05);插管后各组BP、HR均有所回升,以A组变化最大,与诱导前比差异有显著性意义(p<0.01);D组插管前、后与基础值比差异无显著性意义(p>0.05)。结论依托咪酯诱导对心血管系统无明显影响,但不能有效抑制气管插管的高血流动力学反应;咪唑安定、异丙酚与咪唑安定联合异丙酚均能有效抑制气管插管的高血流动力学反应,但咪唑安定、异丙酚诱导后对血流动力学影响较大,应引起临床上的注意,咪唑安定联合异丙酚麻醉诱导血流动力学更平稳。

EFFECT OF FOUR KINDS OF IN HEMODYNAMIC ANESTHESIA INDUCTION AND TRACHEAL INTUBATION IN HEMODYNAMIC

Objective To compare the effects of the etomidate,propofol.midazolam and propofol ＋ midazolam on the hemodynamic response during induction and intubation of general anesthesia. Methods Sixty patients, ASAⅠ - Ⅱ, 22 - 60Y, were divided ramdomly into four groups ： groupA （ etomidate, n = 15 ） , groupB （ midazolam, n = 15 ） , groupC （propofol） , group D （ midazolam ＋ propofol）. Patients received fentenyl 3 ug/kg, veeuronium 0. 1 mg/ kg, etomldate 0.3 mg/kg in group A, mldazolam 0. 3 mg/kg in group B, propofol 2mg/kg in group C, midazolam 0. lmg/kg ＋ propofol lmg/kg in group D for induction and intubation at 5min after induction. The vital signs（ BP, HR, Spo2） during induction and intubation were reeored. Results After induction, the BP and HR decreased in all groups. It singnifieantly decreased in group B and C（p 〈0.05）. The BP and HR were ascended in all groups after intubating it was significantly different with perinduction in group A（p 〈0.01）. it was no significanfly different between perinduction and postinduction in groupB,C and D. Conclusion The etomidate could not depress the hight haemodynamic response to laryngoscopy and tracheal intubation effectively; propofol, midazolam and propofol ＋ midazolam could depress the haemodynamic response to laryngoscopy and tracheal intubation effectively, but propofol ＋ midazolam has more stability haemodynamic.