四种常用静脉麻醉药对老年病人血液动力学影响的比较

目的 探讨脑电双频指数(BIS)为50时,硫喷妥钠、丙泊酚、咪唑安定、依托咪酯用于老年病人全麻诱导的剂量及其对血液动力学的影响。方法 65岁以上的老年病人48例,随机分为四组：硫喷妥钠组,丙泊酚组,咪唑安定组,依托咪酯组。四组均缓慢静注,并且用HXD-1型脑电监测仪测量每例病人的BIS。当BIS逐渐下降至50时停止静注,分别于注药前、注药后1、3、5、10min用Rheo Cardio Monitor连续非创伤性血液动力监测仪记录和计算出血液动力学有关参数。结果 BP下降以丙泊酚组为显著。丙泊酚组和硫喷妥钠组的PEP/LVEF比值明显增加,但丙泊酚组＞硫喷妥钠组。除依托咪酯组以外其他各组的每搏指数(SD、心脏指数(CI)、射血速率(EV)和每搏功(LVP)均有不同程度的降低,但以丙泊酚组为显著。依托咪酯组体循环血管阻力(SVR)无明显变化,硫喷妥钠组和咪唑安定组均有不同程度的升高,以咪唑安定组为显著,丙泊酚组明显下降。舒张末容量(EDV)咪唑安定组明显下降,其他各组无明显变化。结论 四种静脉麻醉药对老年病人血液动力学的影响由大到小依次为丙泊酚＞咪唑安定＞硫喷妥钠＞依托咪酯。BIS为50时,老年病人各静脉麻醉药的等效剂量为硫喷妥钠4mg／kg、丙泊酚1．2mg／kg、咪唑安定0．16mg／kg、依托咪酯0．34mg／kg。对于心功能较差和血容量不足的老年病人全麻诱导,依托咪酯是首选的静脉麻醉诱导药。

Effects of thiopental,propofol,midazolam or etomidate on hemodynamics in geratics

Objective To investigate the effects of thiopental,propofol,midazolam or etomidate on hemodynamics of geratics.Methods Forty eight elderly patients were randomly divided into four groups with 12 cases each:thiopental group,propofol group,midazolam group and etomidate group.All proups received anesthetics iv.slowly until BIS went down to 50.Hemodynamic parameters were measured with Rheo Cardio Monitor.Results Blood pressure decreased most intensely in propofol group.The increases in PEP/LVET were significant in both groups of propofol and thiopental.The decreases in stroke index,cardiac index,ejection velocity and left ventricle power were significant in all groups except for etomidate group.The increases in system vascular resistance were significant in thiopental group and midazolam group.The decrease in system vascular resistance was significant in propofol group.End diastolic volume decreased in midazolam group significantly.Conclusions The degree of effects on hemodynamics in elderly patients is in an order of propofol>midazolam>thiopental>etomidate.When BIS went down to 50,the doses of thiopental,propofol,midazolam and etomidate were 4mg/kg,1 2mg/kg,0 16mg/kg and 0 34mg/kg respectively.Etomidate is the best intravenous anesthetics for elderly patients. [