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无阿片药麻醉诱导对气管插管患者血流动力学的影响

Effect of opioid-free anesthesia induction on hemodynamics of patients with endotracheal intubation

    摘要
  • 摘要:
    目的 观察无阿片药麻醉(OFA)诱导对气管插管患者血流动力学的影响。
    方法 选取择期普外科手术行全身麻醉气管插管的患者60例，随机分为观察组和对照组，每组30例。观察组先静脉泵注右美托咪定0.5 μg/kg负荷量5 min, 而后依次静脉注射丙泊酚2.0 mg/kg、利多卡因1.5 mg/kg、琥珀胆碱2.0 mg/kg行麻醉诱导。对照组依次静脉注射咪达唑仑0.02 mg/kg、丙泊酚2.0 mg/kg、舒芬太尼0.3 μg/kg、琥珀胆碱2.0mg/kg行麻醉诱导。2组均在注射琥珀胆碱1 min后行气管插管，并在30 s内完成插管。比较2组入室时(T0)、麻醉诱导后(T1)、插管即刻(T2)、插管后1 min(T3)、插管后3 min(T4)、插管后5 min(T5)的血压舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)及心率与收缩压的乘积(RPP)。
    结果 与T0比较，对照组患者T1、T5的SBP、DBP、MAP均下降，差异有统计学意义(P < 0.05); 与T0比较，观察组患者T1、T4、T5的HR下降，对照组患者T4、T5的HR下降，差异均有统计学意义(P < 0.05); 与T0比较, 2组患者T1、T4、T5的RPP均下降，差异有统计学意义(P < 0.05)。观察组患者T1、T4、T5的SBP、DBP、MAP以及T5的RPP高于对照组, T1的HR低于对照组，差异均有统计学意义(P < 0.05)。
    结论 右美托咪定和利多卡因复合丙泊酚的OFA诱导对气管插管引起的心血管反应有一定的抑制作用，血流动力学变化相对稳定。

     

    Abstract:
    Objective To observe the effect of opioid-free anesthesia (OFA) induction on hemodynamics of patients with endotracheal intubation.
    Methods A total of 60 patients with general anesthesia and endotracheal intubation in elective general surgery were randomly divided into observation group and control group, with 30 cases in each group. In the observation group, a dose of 0.5 μg/kg dexmedetomidine was firstly injected intravenously for 5 min, followed by 2.0 mg/kg propofol, 1.5 mg/kg lidocaine and 2.0 mg/kg succinylcholine intravenously for anesthesia induction. In the control group, 0.02 mg/kg midazolam, 2.0 mg/kg propofol, 0.3 μg/kg sufentanil and 2.0 mg/kg succinylcholine were successively injected intravenously for anesthesia induction. In both groups, endotracheal intubation was performed at 1 min after succinylcholine injection, and the intubation was completed within 30 seconds. The blood pressure diastolic pressure (DBP), systolic pressure (SBP), mean arterial pressure (MAP), heart rate (HR) and rate-pressure product (RPP) were compared between the two groups at the time points of hospital admission (T0), after anesthesia induction (T1), immediately after intubation (T2), 1 min after intubation (T3), 3 min after intubation (T4), and 5 min after intubation (T5).
    Results Compared with indexes at T0, the SBP, DBP and MAP at T1 and T5 in the control group decreased significantly (P < 0.05); compared with index at T0, the HR at T1, T4 and T5 in the observation group and at T4 and T5 in the control group decreased significantly (P < 0.05); compared with index at T0, the RPP at T1, T4 and T5 in both groups decreased significantly (P < 0.05). In the observation, the SBP, DBP and MAP at T1, T4 and T5 as well as the RPP at T5 were significantly higher than those in the control group, while the HR at T1 was significantly lower than that in the control group (P < 0.05).
    Conclusion OFA induction of dexmedetomidine and lidocaine combined with propofol has a certain inhibitory effect on cardiovascular response induced by tracheal intubation, and hemodynamic changes are relatively stable.

     

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