升压药物预注射对全凭静脉麻醉下腹部手术患者升压反应性和术后恢复的影响

Effects of Vasopressors Pre-infusion on Vasopressor Response and Postoperative Recovery in Patients Undergoing Lower Abdominal Surgery Under Total Intravenous Anesthesia

关键词:  全凭静脉麻醉  麻黄碱  去氧肾上腺素  脑电双频指数  升压反应性

Key words:  intravenous anesthesia  methamphetamine  norepinephrine  bispectral index  vasopressor response  pre-injection

摘要:

目的 探讨全凭静脉麻醉下腹部手术中预注射不同升压药物对患者升压反应性、手术指标、不良反应指标、脑电双频指数(bispectral index，BIS)及复苏时间的影响。方法 选择中国人民解放军联勤保障部队第九八八医院择期行下腹部手术患者300例，按照不同预注射药物分为生理盐水组、麻黄碱组、去氧肾上腺素组，各100例，所有患者均行全凭静脉麻醉。记录麻醉诱导前(T0)、注射药物后1 min(T1)、注射药物后3 min(T2)、注射药物后5 min(T3)、注射药物后7 min(T4)、注射药物后9 min(T5)时患者收缩压(systolic blood pressure，SBP)、舒张压(diastolic blood pressure，DBP)、平均动脉压(mean arterial pressure，MAP)、心率(heart rate，HR)、心输出量(cardiac output，CO)、外周血管阻力(systemic vascular resistence，SVR)、每搏量变异度(stroke volume variation，SVV)等血流动力学指标；记录患者术中低血压、高血压、术后心动过缓、心动过速、恶心呕吐等不良反应发生情况；记录T0—T5时BIS值及停止靶控输注后BIS升至65，75，85，95及患者呼吸恢复、神志恢复和拔管的时间。结果 麻黄碱组SBP、DBP、MAP、HR、CO在T1—T5时均显著高于生理盐水组(P<0.05)；去氧肾上腺素组SBP、DBP、MAP在T1—T5时均显著高于生理盐水组，HR在T1—T5时显著低于生理盐水组(P<0.05)。麻黄碱组和去氧肾上腺素组低血压及总不良反应发生率均显著低于生理盐水组(P<0.05)。麻黄碱组BIS值在T1—T5时均显著高于生理盐水组(P<0.05)，去氧肾上腺素组BIS值与生理盐水组相比无统计学差异。麻黄碱组BIS值恢复至65，75的时间显著低于生理盐水组(P<0.05)，但BIS值恢复至85，95和呼吸恢复、神志恢复、拔管时间与生理盐水组相比无统计学差异；去氧肾上腺素组与生理盐水组相比，BIS值恢复时间和复苏时间均无统计学差异。结论 下腹部手术患者麻醉期预注射麻黄碱和去氧肾上腺素能够升高血压，减少围术期低血压发生率，且不影响患者复苏时间。

Abstract:

OBJECTIVE To investigate the effects of pre-injection of different antihypertensive drugs in patients undergoing lower abdominal surgery under total intravenous anesthesia on hypertensive response, surgical parameters, adverse reaction indexes, bispectral index(BIS) and resuscitation time. METHODS There were 300 patients who underwent elective lower abdominal surgery in 988th Hospital, Joint Logistic Support Unit, and divided into normal saline group, ephedrine group and norepinephrine group according to different pre-injection drugs, with 100 cases in each group. All the patients received intravenous anesthesia. Systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), heart rate(HR), cardiac output(CO), systemic vascular resistance(SVR) and stroke volume variation(SVV) were recorded before anaesthetic induction(T0), 1 min after drug injection(T1), 3 min after drug injection(T2), 5 min after drug injection(T3), 7 min after drug injection(T4), and 9 min after drug injection(T5). The adverse reactions including intraoperative hypotension, hypertension, postoperative bradycardia, tachycardia, nausea and vomiting were recorded. BIS values were recorded at T0-T5. At the same time, the time of BIS values increased to 65, 75, 85, 95 and the time of breath recovery, consciousness recovery and extubation were recorded. RESULTS SBP, DBP, MAP, HR and CO in ephedrine group were significantly higher than those in normal saline group at T1-T5(P<0.05). SBP, DBP and MAP in norepinephrine group were significantly higher than those in normal saline group at T1-T5, and HR was significantly lower than those in normal saline group at T1-T5(P<0.05). The incidence of hypotension and total adverse reactions in ephedrine group and norepinephrine group was significantly lower than that in normal saline group(P<0.05). BIS values in ephedrine group were significantly higher than those in normal saline group at T1-T5(P<0.05), but there was no significant difference between norepinephrine group and normal saline group. The time when BIS values recovered to 65 and 75 in ephedrine group was significantly lower than that in normal saline group(P<0.05), but there was no significant difference in BIS value recovered to 85 and 95, respiratory recovery, consciousness recovery and extubation time between ephedrine normal saline group and normal saline group. There was no significant difference of BIS recovery time and consciousness recovery time between norepinephrine group and normal saline group. CONCLUSION Pre-injection of ephedrine and norepinephrine in patients undergoing lower abdominal surgery during surgical anesthesia can increase blood pressure, reduce the incidence of adverse reactions, and do not affect the time of resuscitation.