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全身麻醉诱导-靶控输注与单次注射丙泊酚期间动脉低血压发生率的比较：一项随机临床试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游宵 编辑：田明德 审校：曹莹
背景：全身麻醉诱导期间动脉低血压的发生率受丙泊酚给药方法的影响，但缺乏对比推注和靶控输注与动脉低血压关系的随机临床试验。本研究旨在比较这两种异丙酚给药方法之间动脉低血压的发生率。
方法：这项前瞻性、随机、单中心、非盲法研究纳入了 60 名接受非心脏手术的患者（年龄 35 至 55 岁）， ASA I 或 II。根据全麻诱导期间异丙酚的给药方法，使用计算机随机分为两组：靶控组，接受4 mg·mL·1的靶控输注，推注组，接受推注输注 2 mg·kg·1。两组还接受咪达唑仑 2 mg、芬太尼 3 mg·kg·1 和罗库溴铵 0.6 mg·kg·1。在麻醉诱导的前 10 分钟内，每 2 分钟记录一次平均动脉压 (MAP)、心率 (HR)、意识水平 (qCON) 和抑制率 (SR)。
结果：TCI 组仍有 27 名患者，Bolus 组有 28 名患者。使用混合效应模型的重复测量分析无法拒绝 MAP (p = 0.85)、HR (p = 0.49)、SR (p = 0.44) 或 qCON (p = 0.72) 中组时间交互作用的零假设 ）。 qCON 平均值差异（TCI 为 60.2，推注为 50.5，p < 0.001）、MAP（TCI 为 90.3，推注为 86.2，p < 0.006）、HR（TCI 为 76.2，推注为 76.9，p = 0.93）， 和 SR（ TCI为0.01，推注为 5.5，p < 0.001），无论时间如何（整个时期的平均值），都显示出一些显著差异。
结论：与靶控输注患者相比，接受丙泊酚推注的患者平均动脉压较低，意识水平变化较大，抑制率较高。然而，群体和时间之间的相互作用效应仍然没有定论。
原始文献：Vale, A. G. G., Govêia, C. S., Guimarães, G. M. N., Terra, L. R., Ladeira, L. C. A., & Essado, G. A. (2024). Comparison of arterial hypotension incidence during general anesthesia induction – target-controlled infusion vs. bolus injection of propofol: a randomized clinical trial. Brazilian Journal of Anesthesiology (English Edition), 74(4), 844503.
Comparison of arterial hypotension incidence during general anesthesia induction − target-controlled infusion vs. bolus injection of propofol: a randomized clinical trial
Abstract
Background: The incidence of arterial hypotension during induction of general anesthesia is influenced by the method of propofol administration, but there is a dearth of randomized clinical trials comparing bolus injection and target-controlled infusion in relation to arterial hypotension. This study seeks to compare the incidence of arterial hypotension between these two methods of propofol administration.
Methods: This prospective, randomized, single-center, non-blinded study included 60 patients (aged 35 to 55 years), classified as ASA physical status I or II, who were undergoing non-cardiac surgeries. They were randomly allocated using a computer to two groups based on the method of propofol administration during the induction of general anesthesia: the Target Group, receiving target-controlled infusion at 4 mg.mL1, and the Bolus Group, receiving a bolus infusion of 2 mg. kg1. Both groups also received midazolam 2 mg, fentanyl 3 mg.kg1, and rocuronium 0.6 mg. kg1. Over the first 10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were recorded every 2 minutes.
Results: Twenty-seven patients remained in the TCI group, while 28 were in the Bolus group. Repeated measure analysis using mixed-effects models could not reject the null hypothesis for the effect of group-time interactions in MAP (p = 0.85), HR (p = 0.49), SR (p = 0.44), or qCON (p = 0.72). The difference in means for qCON (60.2 for TCI, 50.5 for bolus, p < 0.001), MAP (90.3 for TCI, 86.2 for bolus, p < 0.006), HR (76.2 for TCI, 76.9 for bolus, p = 0.93), and SR (0.01 for TCI, 5.5 for bolus, p < 0.001), irrespective of time (whole period means), revealed some significant differences.
Conclusion: Patients who received propofol bolus injection exhibited a lower mean arterial pressure, a greater variation in the level of consciousness, and a higher suppression rate compared to those who received it as a target-controlled infusion. However, the interaction effect between groups and time remains inconclusive.
