丙泊酚靶控输注用于重症心脏瓣膜病患者全麻诱导.pdf

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1、I临床麻醉学杂志2014年2月第3O卷第2期JC1inAnesthesiol，February2014，Vo1．3O，No．2．临床研究．丙泊酚靶控输注用于重症心脏瓣膜病患者全麻诱导郑俊奕王可佳陈鸶马武华【摘要】目的探讨丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性和有效性。方法重症心脏瓣膜病患者47例，随机分成丙泊酚组(P组，n一24)和依托咪酯组(E组，一23)。P组以丙泊酚靶控输注，初始血浆靶浓度1．0／,g／ml，采用改良警觉／镇静(MOAA／S)评分行镇静评分，每2分钟递增靶浓度0．2／~g／ml，至患

2、者MOAA／S评分≤1分时给予芬太尼5“g／kg、维库溴铵0．1mg／kg。E组使用依托咪酯0．25～0．30mg／kg和同剂量的芬太尼、维库溴铵并行气管插管。记录入室(T)、MOAA／S评分≤1分(Tz)、诱导期收缩压最低点(T3)、插管前(T)、插管完毕(Ts)、插管后5min(Ts)时的SBP、DBP、HR、CVP；记录血管活性药物的使用情况。结果与T时比较，P组T2～T6时SBP、DBP明显下降，HR明显减慢(P

3、明显减慢(P

4、onofgeneralanesthesiainpatientswithseverevalvulaheartdiseaseZHENGJun．yi，WANGKe-jia，CHENSi，MA．hua．DeparmentofAnesthesiology，eFirstAffiliatedHospital。GuangzhouUniversityofCM，Guangzhou510405。ChinaCorrespondingauthor：MAWu-hua，Emaif：gzmwh@outlook．corn[Abstract]Objective

5、Toassessthesafetyandfeasibilityofthetitrimetrictarget-controlledinfusion(TCI)ofpropofolforinductionofgeneralanesthesiainpatientswithseverevalvularheartdisease．MethodsForty-sevenpatientswererandomlyallocatedtogroupP(n一24)andgroupE(一23)toreceivepropofolbyTCIoretomida

6、teforinductionofgeneralanaesthesia．IngroupP，theinitialtargetplasmaconcentrationwassetat1．0／~g／mlandincreasedby0．2／zg／mlevery2minutesuntilthemodifiedobserver’sassessmentofalertnessandsedation(MOAA／S)score≤1．GroupEreceivedaDetomidateinfusionof0．25—0．30mg／kg．Fentanyl5

7、~g／kgandvecuroniumbromide0．1mg／kgwereadministratedbeforeintubationinbothgroups．HemodynamicindicatorsincludingSBPandDBP，HRandcentralvenuspressure(CVP)atbaseline(T1)，MOAA／Sscore≤1(T2)，thelowestpointofSBP(Ta)，preintubation(T4)，postintubation(T5)andfiveminpostintubatio

8、n(T6)wererecorded．Vasomotordrugsifusedwerealsorecorded．ResulIsComparedwithT1，SBP，DBPandHRatT2一T6ingroupEweredecreasedsignificantly(Pd0．05orP