丙泊酚联合不同药物诱导全身麻醉在眼科手术中的效果比较

Discussion on different induction methods of general anesthesia for ophthalmic surgery

摘要:

目的 比较丙泊酚复合顺式阿曲库铵与丙泊酚复合去氧肾上腺素对于眼科手术患者全身麻醉诱导期间血流动力学及呼吸的影响。方法 选择需在全身麻醉喉罩通气下行眼科手术的患者60 例，采用随机数字表法分为两组，丙泊酚复合顺式阿曲库铵组（PC 组）与丙泊酚复合去氧肾上腺素组（PP 组），每组30 例。PC组麻醉诱导：予咪达唑仑0.05 mg/kg，舒芬太尼0.20μg/kg，丙泊酚1.00 mg/kg，顺式阿曲库铵0.05 mg/kg ；PP 组麻醉诱导：予咪达唑仑0.05 mg/kg，舒芬太尼0.20μg/kg，丙泊酚2.00 mg/kg，去氧肾上腺素0.50 mg/kg ；诱导完成后置入可弯曲喉罩；予丙泊酚4 mg/（kg·h），七氟烷2% 新鲜气流量2 L/min 麻醉维持。喉罩置入后若自主呼吸存在则保留自主呼吸；如不存在则辅助呼吸5 min，恢复自主呼吸后保留自主呼吸，不能恢复自主呼吸则改为控制呼吸。比较两组患者麻醉诱导前（T0）、诱导后（T1）、喉罩置入后（T2）、喉罩置入后5 min（T3）心率和血压的变化以及不同诱导方式对呼吸的影响。结果 在T0、T1 和T2 时两组患者的心率血压比较急，差异无统计学意义（P >0.05）；T3 时两组患者心率、血压比较，差异有统计学意义（P <0.05），PC组患者的心率、血压高于PP 组，PC 组患者的心率、血压在T3 时高于T2、T1 和T0，PP 组患者的心率、血压在T3 时低于T2、T1 及T0。PC 组喉罩置入后5 min 有16 例患者自主呼吸不能恢复，需控制呼吸，PP 组喉罩置入后5 min 有1 例患者自主呼吸不能恢复需控制呼吸，两组比较差异有统计学意义（P <0.05）。结论 丙泊酚复合去氧肾上腺素进行麻醉诱导对于喉罩通气保留自主呼吸的全身麻醉患者血流动力学影响和呼吸抑制较小，是一种更好的选择。

Abstract:

Objective To compare the effect of Propofol combined with Cisatracurium and Propofol combined with Phenylephrine on hemodynamics and respiration during general anesthesia for ophthalmic surgery. Methods Sixty patients who underwent ophthalmic surgery under general anesthesia were randomly divided into Propofol combined with Cisatracurium group (group PC) and Propofol combined with Phenylephrine group (group PP) with 30 cases in each group. The patients in the group PC were treated with Midazolam 0.05 mg/kg,Sufentanil 0.20 μg/kg, Propofol 1 mg/kg, and Cisatracurium 0.05 mg/kg; while those in the group PP received Midazolam 0.05 mg/kg, Sufentanil 0.20 μg/kg, Propofol 2.00 mg/kg, and Phenylephrine 0.50 mg/kg. After induction,a flexible laryngeal mask was placed, Propofol 4 mg/(kg?h) was given, Sevoflurane 2% fresh air flow 2 L/min was used for anesthesia maintenance. After laryngeal mask was placed, if spontaneous breathing was present it was retained; after absence of auxiliary breathing for 5 minutes, if spontaneous breathing was restored it was retained, in case spontaneous breathing could not be restored, controlled breathing was used. The changes of heart rate and blood pressure and the effect of different induction methods on respiration were compared between the two groups before induction of anesthesia (T0), after induction (T1), after laryngeal mask implantation (T2) and 5 minutes after laryngeal mask implantation (T3). Results There were no significant differences in heart rate or blood pressure between the two groups at T0, T1 and T2 (P > 0.05). At T3 the heart rate and blood pressure of the group PC were higher than those of the group PP (P < 0.05). In the group PC, the heart rate and blood pressure at T3 were statistically higher than those at T2, T1 and T0 (P < 0.05); whereas in the group PP, the heart rate and blood pressure at T3 were statistically lower than those at T2, T1 and T0 (P < 0.05). After the placement of laryngeal mask for 5 minutes, 16 patients in the group PC but only 1 patient in the group PP could not restore spontaneous breathing and needed controlled breathing, the difference was statistically significant (P < 0.05). Conclusions Propofol combined with Phenylephrine is an effective method for the induction of general anesthesia in patients undergoing ophthalmic surgery, and has less influence on hemodynamics and respiration of patients who retain spontaneous respiration by laryngeal mask ventilation.