靶控输注依托咪酯用于老年人髋关节手术全身麻醉维持效果观察

目的比较依托咪酯乳剂复合芬太尼、瑞芬太尼或舒芬太尼全静脉麻醉分别用于老年人髋关节手术的有效性及安全性。方法 ASAⅠ~Ⅲ级择期髋关节手术老年患者60例,随机分为3组:芬太尼组(F组)、瑞芬太尼组(R组)和舒芬太尼组(S组),每组20例。快速诱导后气管插管,麻醉维持各组均靶控输注(TCI)依托咪酯1~2μg/mL,F组间断静脉注射芬太尼1~2μg/(kg.h),R组静脉输注瑞芬太尼0.5~1μg/(kg.min),S组切皮前5 min静脉注射舒芬太尼0.5~5μg/kg,维持BIS值40~60;记录麻醉诱导前(基础值T0)、气管插管前即刻(T1)、气管插管后3 min(T2)、切皮(T3)、骨膜剥离(T4)时的平均动脉压(MAP)及心率(HR);记录手术时间、睁眼时间、拔管时间和PACU停留时间;于拔管后即刻、拔管后30、60 min和离开PACU时采用警觉/镇静评分(OAA/S)评价意识状态;记录术中和PACU期间不良反应发生情况。结果与基础值相比,3组T1时MAP和HR均下降,T3、T4时,F、S组MAP升高,F组HR升高,R、S组HR降低(P<0.05);与F组比较,R组T3、T4时MAP、HR降低,S组T3、T4时HR降低;与S组比较,R组T3、T4时MAP降低(P<0.05)。R组与F组、S组比较,F组与S组比较,睁眼时间、拔管时间和PACU停留时间缩短,拔管后即刻和拔管30 min OAA/S评分升高(P<0.01或P<0.05);R组苏醒期躁动发生率高于F组、S组(P<0.05)。结论依托咪酯复合芬太尼、瑞芬太尼或舒芬太尼全凭静脉麻醉用于老年人髋关节手术均能取得满意的麻醉效果。依托咪酯复合瑞芬太尼术中血流动力学更趋稳定,术后苏醒迅速,较另两者更佳。

Efficacy of target controlled infusion of etomidate in general anesthesia for hip joint surgery in elderly patients

Objective To compare the efficacy and safety of total intravenous anesthesia(TIVA) of etomidate combined with fentanyl,remifentanil or sufentanil respectively for hip joint surgery in elderly patients.Methods Sixty ASA Ⅰ to Ⅲ patients undergoing hip joint surgery were randomized into group F(etomidate combined with fentanyl),group R(etomidate with remifentanil) and group S(etomidate with sufentanil),with 20 patients in each group.All the patients were induced and then intubated mechanically.To keep BIS at 40 to 60,anesthesia was maintained by target controlled infusion(TCI) of etomidate 1-2 μg/mL in all the groups,combined with fentanyl 1-2 μg/(kg·h) as an intravenous bolus intermittently in group F,with remifentanil 0.5-1 μg/(kg·min) infused continuously in group R,with sufentanil 0.5-5 μg/kg-1 as a bolus intravenously 5 min prior to skin incision in group S.The mean arterial pressure(MAP) and heart rates(HR) prior to anesthesia induction(baseline T0),immediately at intubation(T1),3 min after intubation(T2),during skin incision(T3) and during periosteal stripping(T4) were recorded.Surgery duration,eye-opening time,extubation time,and length of stay in postanesthesia care unit(PACU) were also recorded.OAA/S scores were used to assess the states of consciousness immediately after extubation,30,60 min after extubation and the moment leaving PACU.Adverse events during operation and stayin PACU were recorded as well.Results Compared with baseline,MAP and HR at T1 were lowered in all three groups,MAP in groups F and S rose at T3 and T4,HR went higher in group F and HR decreased in groups R and S(P<0.05).Compared with group F,MAP and HR dropped at T3 and T4 in group R,and HR decreased at T3 and T4 in group S.Compared with group S,MAP was lowered at T3 and T4(P<0.05) in group R.Eye-opening time,extubation time and length of stay in PACU were shorter,and the OAA/S scores immediately and at 30 min after extubation were higher in group R than in groups F and S,also in group F than in group S(P<0.01 or P<0.05).The incidence of restlessness was higher in group R than in groups F and S(P<0.05).Conclusion Total intravenous anesthesia using etomidate combined with fentanyl,remifentanil or sufentanil can achieve satisfactory anesthetic efficacy for hip joint surgery. Patients′ hemodynamics is more stable during operation and recovery from anesthesia is faster,which is better than the other two means.