The Hemodynamic Effects of Continuous Intravenous Infusion of Propofol at Higher Rates

高劑量Propofol持續性靜脈注射之血液動力學變化

曾稼志(Chia-Chih Tzeng) ； 張傳林(Chuan-Lin Chang) ； 葉富欽(Fuh-Cheng Yeh) ； 王蔣驊(Jiiang-Hwa Wang) ； 周振揚(Cheng-Yang Chou)

《Acta Anaesthesiologica Sinica》 32卷2期 (1994/06) Pp. 83-88

摘要

The new formula of propofol was introduced in 1985. Because of its characteristics of rapid onset and elimination, it was often used as a drug of induction and maintenance of total intravenous anesthesia. However, the hemodynamic effects of propofol was still controversial. The present study was to observe its hemodynamic reactions at higher infusion rate. Hemodynamic studies were performed in 11 female patients, 17 to 54 years old, ASA class I-II, presenting for major lower abdominal operation. Patients with heart, lung, liver, or endocrine disease were excluded. No premedication was given before anesthesia. A radial arterial line and a swan-ganz catheter were inserted under local anesthesia. Cardiac output (CO), arterial blood pressure (ABP), central venous pressure (CVP), pulmonary arterial pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were obtained before induction to foster systemic vascular resistance index (SVRI), left ventricular systolic work index (LVSWI), right ventricular systolic work index (RVSWI), and pulmonary vascular resistance index (PVRI), cardiac index (CI) by an H/p computer analyzer. Propofol (2 mg/kg) was combined with succinylcholine (1.5 mg/kg) for induction. Anesthesia was maintained with propofol and norcuron. The infusion rates of propofol were 10 mg/kg/hr during the first 30 minutes and 8 mg/kg/hr during the following 30 minutes, norcuron, 0.1 mg/kg initially and 1 mg for maintenance after 30 minutes. Normal saline was infused 1000 to 1500 ml in study period to maintain higher preload. Post induction hemodynamic data were collected at the 5th, 15th, 30th, 60th min after induction. The results showed that propofol decreases systolic blood pressure (SBP), mean arterial blood pressure (MBP), CO, CI, LVSWI, RVSWI without changing heart rate (HR), SVRI, and PVRI. The decrease of BP and cardiac output without changing HR and SVRI indicates that it also has the effects of vascular dilatation and baroreceptor reset. In conclusion, propofol has the effects of cardiac depression, vascular dilatation and baroreceptor reset.

關鍵字

propofol ； hemodynamic ； induction ； continuous infusion

並列摘要

Propofol為一新靜脈麻醉劑，因其在藥物動力學方面有快速排出的特性，適合用來作持續靜脈注射麻醉之用。唯對其血液動力學作用機轉（hemodynamic）仍有相當的爭議。本研究在觀測持續性全靜脈麻醉一小時內血液動力學之變化。研究對象為11位下腹部手術女性患者，年齡由17～54歲，除了婦科疾病外都没有其他系統疾患。用propofol（2 mg／kg）加succinylcholine（1.5 mg／kg）作誘導，插管後先用propofol（10 mg／kg／hr）滴注30分鐘，然後再改成8 mg／kg／hr繼續30分鐘，共60分鐘，並用norcuron（0.1 mg／kg）作肌肉鬆弛劑。病人進開刀房後插入動脈導管及肺動脈導管，測量心跳、血壓、肺動脈壓及心輸出量，同時計算出血管阻力指數、心室工作量指數來作比較，測量時間爲麻醉誘導前及誘導後5分鐘、15分鐘、30分鐘、60分鐘。所得資料用無母數分析作比較。（P＜0.05代表有意義差別）結果：本研究發現持續性靜脈注射propofol在沒有手術刺激的狀況下會造成血壓降低、心輸出指數降低及心室收縮力之降低，但週邊阻力及心率都未因降低血壓而改變，顯示propofol有心臟收縮抑制、心率降低及血管擴張之作用。