微量泵输注异丙酚应用于重症肌无力胸腺瘤切除麻醉体会.docVIP

微量泵输注异丙酚应用于重症肌无力胸腺瘤切除麻醉体会 　【关键词】 微量 　　摘要：目的：观察采用微量泵输注异丙酚在重症肌无力胸腺瘤切除术的临床应用。方法：24例ASAⅠ～Ⅱ级，胸腺瘤伴重症肌无力（MG）患者行胸腺瘤切除，随机分为两组A组和B组，均采用慢诱导气管内全麻；麻醉维持：A组以吸入（2～3）％氨氟醚和间断静注芬太尼。B组：微量泵持续输注异丙酚6～9mg/kg/h，和间断静注芬太尼。术中酌情给予小剂量卡肌宁。术中监测血流动力学变化。结果：B组病人整个麻醉手术中血流动力学稳定，（Pgt;0.05）,苏醒明显快于A组，术后4小时绝大多数病人镇静程度为2或3级。而A组病人气管插管及切皮时MAP显著升高（Plt;0.05），插管时HR变化显著（Plt;0.01）。结论：采用微量泵连续静脉给药可使血药浓度维持相对稳定状态，使麻醉平稳，顺利。病人苏醒快，拔管早，安全有效利于重症肌无力病人术后呼吸功能的恢复。 　　关键词:微量泵; 异丙酚;重症肌无力 　　Anesthesia Experience of Propofol Infusion in Minim Pump Applied in Thymectomy for Myasthenia Gravis ( MG ) 　　Abstract： Objective： To oberserve clinical appliance of infusion propofol in minim pump in thymectomy for MG. Method： 24 adult patients, ASA grade Ⅰ～Ⅱ, thymectomy for MG, were randomly divided into two groups A and B. They were all slowly induced endotracheal intubatton. Anaesthesia maintain group A: inhalation of 2％～3％ enflurance and intermittent bolus of fentanyl; group B: infusion propofol in minim pump with 6～9mg/kg/h, and intermittent bolus of fentanyl. In the operation deliver small dose tiacrium extenuatorily. Hemodynamics was recorded during the whole procedures. Results： In group B the hemodynamics was kept stable （Pgt;0.05）;in group A MAP increased markedly during intubation and incision （Plt;0.05）.The analepsia duration was shorten in group B as compared with that in group A （Plt;0.05）.Conclusion： Infusion propofol in minim pump can make drug consistence in blood steady , make anaesthesia calm and kilter. The patients came round rapidly and may be early pulled pipe out , so benefiting for their recovery of respiratory function. 　　Key words:Minim pump;Propofol;Myasthenia gravis 　　本文总结近几年来，24例重症肌无力胸腺瘤切除术中，采用微量泵输注异丙酚行静脉全麻，取得满意效果，现报告如下： 　　1 资料和方法 　　1.1 一般资料：本文24例胸腺瘤伴有MG患者行手术治疗，男15例，女9例，年龄17～70岁。其中眼肌型10例，全身型14例，轻重不一，伴有眼球肌群受累，咀嚼吞咽困难或呼吸不畅等。病程1月至10年，术前口服吡啶斯的明治疗者9例。 　　1.2 麻醉方法：术前30min阿托品0.5mg皮下注射。采用慢诱导气管内插管全身麻醉;静注咪唑安定0.05mg/kg,度冷丁50mg,氟哌啶25mg，静脉药起效后，行环甲膜穿刺，气管内注入2％利多卡因2ml,3min后行气管插管。 　　1.3 麻醉维持：随机分为两组，每组12例，A组吸入氨氟醚，B组微量泵输注异丙酚，6～9mg/kg