持续静脉输注硫酸镁对丙泊酚有效靶浓度及病人血流动力学相关参数的影响.docVIP

持续静脉输注硫酸镁对丙泊酚有效靶浓度及病人血流动力学相关参数的影响 【摘要】 目的 以脑电双频指数（BIS）为麻醉深度指标，研究持续静脉输注硫酸镁对丙泊酚有效靶浓度及病人血流动力学相关参数的影响。 方法 选择上腹部择期手术病人60例，ASA Ⅰ～Ⅱ级，随机分为丙泊酚组（P组）、硫酸镁小剂量组（M1组）和硫酸镁大剂量组（M2组），每组20例，所有病人均采用静脉复合麻醉。麻醉诱导时3组丙泊酚的初始靶浓度均设为2.0 mg/L，M1组、M2组在气管内插管前分别静注硫酸镁15、25 mg·kg-1，术中分别持续静脉输注硫酸镁6、9 mg·kg-1·h-1，根据BIS值变化调节丙泊酚靶浓度，使BIS值维持在45～55。记录诱导前、插管前和后、切皮前和后、术中30及60 min、术毕等时间点的血流动力学相关参数及丙泊酚靶浓度的变化。结果 P组术中各时点及全程平均丙泊酚有效靶浓度均显著高于M1组和M2组（F= 11.21～26.32，q＝4.96～9.11，Plt;0.01）；P组丙泊酚用量显著高于M1组和M2组(F=105.82，q=15.01、19.69，Plt;0.01)，M1组高于M2组（q=4.68，Plt;0.05）。气管内插管后M1组和M2组MAP、HR低于P组（F=5.04、3.66，q＝1.39～4.22，Plt;0.05），且较为稳定；手术全程中M1组和M2组的MAP、HR控制较为理想，在多个时间点低于P组(F=3.27～8.80，q=3.10～5.53，Plt;0.05),而M1、M2组间差异无统计学意义。术毕3组血清镁离子浓度均在安全范围内。结论 持续静脉输注硫酸镁可以降低丙泊酚的有效靶浓度，减少丙泊酚用量，维持术中相关参数更加稳定。 【关键词】 硫酸镁 二异丙酚 脑电描记术 相关参数 ［ABSTRACT］ObjectiveTo investigate the influence of continuous intravenous infusion of magnesium sulfate on the target effectivesite concentration of propofol by TCI with BIS as the index of depth of anesthesia.MethodsSixty ASA ⅠⅡ patients, scheduled for elective abdominal surgery, were randomly divided into three groups: group propofol (group P, n=20), lowdose magnesium sulfate group (group M1, n=20), and highdose magnesium sulfate group (group M2, n=20). All the patients were treated with TIVA. The initial target effectivesite concentration of propofol was set at 2.0 mg/L during induction. Those in groups M1 and M2 were given magnesium sulfate of 15 and 25 mg·kg-1 bolus, respectively, followed by continuous infusion of 6 and 9 mg·kg-1·h-1 before tracheal intubation to maintain BIS at 45-55. MAP, HR, BIS and target effectivesite concentration of propofol TCI were continuously recorded during anesthesia.ResultsComparing groups M1 and M2, the average target effectivesite concentration of the whole range and the concentration of each phase of operation were increased significantly in group P（F=11.21－26.32,q=4.96-9.11,Plt;0.01）. The total dose of propofol TCI was higher in group P than that in groups M1 and M2