Łasińska-Kowara Magdalena, Kardel-Reszkiewicz Ewelina, Owczuk Radosław
Klinika Anestezjologii i Intensywnej Terapii, Gdański Uniwersytet Medyczny, Gdańsk.
Anestezjol Intens Ter. 2009 Jul-Sep;41(3):135-9.
Haemodynamic changes during general anaesthesia are still being widely investigated. Although propofol and sevoflurane are commonly used anaesthetic agents, there is a lack of comparative studies assessing their influence on haemodynamic parameters. We have assessed whether the effects of target-controlled propofol anaesthesia on HR, MAP and cardiac output, are different from those seen with a sevoflurane-based protocol.
ASA I and II females, scheduled for elective breast surgery, were studied. After premedication with midazolam and intravenous induction with propofol, fentanyl and vecuronium bromide, general anaesthesia was maintained with either 1 MAC sevoflurane in oxygen/air (group S), or a target-controlled infusion of 3 micromL(-1) propofol (group P). Both groups received additional fentanyl. Heart rates and mean arterial pressures were noted and compared. Stroke volumes, cardiac outputs and cardiac indexes were measured every 3 min, using a non-invasive carbon dioxide rebreathing method (NICO).
Fifty-seven patients were enrolled in the study. Comparisons between the groups revealed a significant decrease in mean heart rate during maintenance of anaesthesia with propofol (p<0.05), but not with sevoflurane. Although cardiac output and cardiac index were lower in group P towards the end of analysis, no statistically significant differences in HR, MAP, SV, CO or CI were found between the groups.
The haemodynamic effect of a target 3 micromL(-1) propofol infusion did not differ significantly from that observed with 1 MAC sevoflurane.
全身麻醉期间的血流动力学变化仍在广泛研究中。尽管丙泊酚和七氟醚是常用的麻醉剂,但缺乏评估它们对血流动力学参数影响的比较研究。我们评估了靶控丙泊酚麻醉对心率、平均动脉压和心输出量的影响是否与基于七氟醚的方案不同。
研究对象为计划进行择期乳房手术的美国麻醉医师协会(ASA)分级为I级和II级的女性患者。在给予咪达唑仑进行术前用药以及使用丙泊酚、芬太尼和维库溴铵进行静脉诱导后,一组患者使用氧气/空气混合气体中1最低肺泡有效浓度(MAC)的七氟醚维持全身麻醉(S组),另一组患者使用靶控输注3微克/毫升的丙泊酚维持全身麻醉(P组)。两组均额外给予芬太尼。记录并比较心率和平均动脉压。使用无创二氧化碳重呼吸法(NICO)每3分钟测量一次每搏量、心输出量和心脏指数。
57例患者纳入本研究。组间比较显示,丙泊酚维持麻醉期间平均心率显著降低(p<0.05),而七氟醚维持麻醉期间则无此现象。尽管在分析末期P组的心输出量和心脏指数较低,但两组之间在心率、平均动脉压、每搏量、心输出量或心脏指数方面未发现统计学上的显著差异。
靶控输注3微克/毫升丙泊酚的血流动力学效应与1 MAC七氟醚观察到的效应无显著差异。