南方医科大学学报

南方医科大学学报 ›› 2006, Vol. 26 ›› Issue (10): 1506-1509.

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不同新鲜气流量对诱导期异氟醚药效学的影响

陈明全； 靳三庆； 王钟兴；   

  1. 中山大学附属第一医院麻醉科； 中山大学附属第一医院麻醉科 广东； 广州510080； 广东；
  • 出版日期:2006-10-20 发布日期:2006-10-20

Effects of different fresh gas flow on pharmacodynamics of isoflurane during anesthesia induction

CHEN Ming-quan, JIN San-qing, WANG Zhong-xing Department of Anesthesia, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China   

  1. 中山大学附属第一医院麻醉科； 中山大学附属第一医院麻醉科 广东； 广州510080； 广东；
  • Online:2006-10-20 Published:2006-10-20

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摘要： 目的探讨不同新鲜气体流量(FGF)对诱导期异氟醚药效学的影响。方法选择ASAⅠ-Ⅱ级全麻下行妇科腹腔镜手术患者60例,年龄18-49岁,随机分为Ⅰ、Ⅱ、Ⅲ三组,每组FGF分别为1、2、3L/min;每组又分为两个亚组,异氟醚挥发器设定浓度(Co)分别为1%、2%,依次记为Ⅰ1、Ⅰ2、Ⅱ1、Ⅱ2、Ⅲ1、Ⅲ2(1、2分别代表Co为1%、2%)6个亚组。气管插管后分别在不同FGF下吸入不同浓度的异氟醚,监测脑电双频指数(BIS)及血流动力学的变化。麻醉诱导前、插管后每3min记录一次收缩压、舒张压、平均动脉压、心率、BIS,同时记录心动过缓和低血压的发生例数,呼吸道异氟醚的吸入浓度(CIiso)和呼出浓度(CEiso)。在观察的过程中不刺激病人,观察完毕开始手术。术后随访有无术中知晓发生。结果不同组别、不同亚组、不同时间点BIS的差异有统计学意义(P<0.05)。BIS与CIiso和CEiso的相关性良好,相关系数分别为R=-0.904和R=-0.893。低血压的发生例数在Ⅲ组和Ⅰ组之间的差异有统计学意义(P<0.01),Ⅱ1组与Ⅱ2组、Ⅰ1和Ⅰ2组之间差异有统计学意义(P<0.05)。各亚组无1例使用阿托品。手术后访视无1例术中知晓。结论在完成麻醉诱导到手术开始,中等FGF(1-3L/min)下吸入1%或2%异氟醚都能使病人处于无意识状态,在相对低流量(1、2L/min)下吸入异氟醚的低血压发生例数要比相对高流量时(3L/min)少。FGF、Co越高,麻醉深度加深越快,同时对血压的影响越大。

Abstract: Objective To investigate the effect of different fresh gas flows (FGFs) on the pharmacodynamics of isoflurane during anesthesia induction. Methods Sixty female ASA class Ⅰ or Ⅱ patients (aged from 18 to 49 years) scheduled for gynecologic laparoscopic surgery were randomly divided into groups Ⅰ, Ⅱ, and Ⅲ (n=20). The FGFs for group Ⅰ, Ⅱ, and Ⅲ was 1, 2 and 3 L/min, respectively, and each group was further divided into two equal subgroups according to the setting concentrations of isoflurane vaporizer (Co), which was 1% in groupsⅠ1, Ⅱ1, and Ⅲ1 and 2% in groupsⅠ2, Ⅱ2, and Ⅲ2. Isoflurane at different setting concentration was administered under different FGF in the patients after tracheal intubation following anesthesia induction. The systolic blood pressure (SBP), diastolic blood pressure (DBP), main arterial blood pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded before anesthesia induction and every 3 min after tracheal intubation. Patients given ephedrine and atropine were also recorded. The patients’ consciousness during anesthesia were followed up and recorded. The inspiratory concentration (CIiso) and expiratory concentration (CEiso) of isoflurane in the airway were monitored and recorded every 3 min. The observation after intubation lasted for 18 min, during which stimulation of the patients was avoided, and the operation began after the observation. Results There was a close correlation between BIS and CIiso and between BIS and CEiso (r=-0.904 and -0.893, respectively). The incidence of hypotension was significantly different between groups Ⅲ andⅠ (P<0.01), and between the subgroups in groups Ⅱ and Ⅰ (P<0.05). No bradycardia occurred and no consciousness reported awareness during anesthesia. Conclusions Between the completion of tracheal intubation and beginning of the surgery, 1% or 2% Co under a moderate FGF (1-3 L/min) may guarantee the patients’ unconsciousness, but hypotension is less likely under a relatively low flow (1-2 L/min) than a higher flow (3 L/min). Higher FGF and Co result in faster induction of deep anesthesia and higher incidence of hypotension. 

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