不同全身麻醉药物诱导对老年患者心功能的影响

目的探讨不同全身麻醉药物诱导对老年患者心功能的影响。方法选择非心脏手术美国麻醉医师协会分级为Ⅰ～Ⅱ级的老年患者75例,随机分为七氟醚组(S组)、丙泊酚组(P组)和咪达唑仑组(M组),每组各25例。3组患者分别在麻醉诱导前(T_0)、诱导插管前1 min(T_1)、插管后2 min(T_2)、插管后5 min(T_3)、插管后10 min(T_4)5个时间点,应用心输出量超声监测仪,监测患者的左心室输出量、每搏输出量、外周血管阻力、峰值速度、净射血时间百分比、心率情况。结果与T_0比较,S组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力均明显下降,差异有统计学意义(P<0.05);P组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力显著下降(P<0.01),左心室输出量、每搏输出量、峰值速度降低,净射血时间延长,差异有统计学意义(P<0.05)。与S组和M组比较,P组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力明显下降,差异有统计学意义(P<0.05);与M组比较,S组T_1、T_2、T_3、T_4时间点的外周血管阻力明显下降,差异有统计学意义(P<0.05)。结论 3种全身麻醉药物均可对老年患者进行安全、有效地诱导;但丙泊酚对老年患者心功能影响最大,咪达唑仑最小。

Comparison of influence of different general anesthetic induction on cardiac function of elderly patients

Objective To investigate the influence of different general anesthetic induction on cardiac function of elderly patients.Methods Seventy-five non-cardiac surgery aged patients were divided into three groups stochastically:sevoflurane group(S),propofol group(P) and midazolam group(M),with 25 cases in each.The left ventricular cardiac output(CO),stroke volume(SV), systemic vascular resistance(SVR),velocity peak(Vpk),ejection time(ET) percentage,heart rate (HR) situation were momitored by ultrasonic cardiac output moitor at five time points including before the induction of general anesthesia(T_0),1 min before intubation(T_1),2 min after intubation (T_2),5 min after intubation(T_3),and 10 min after intubation(T_4).Results Compared with the situation at T0,mean arterial pressure(MAP) and SVR of group S and group M declined obviously (P<0.05);CO,SV,Vpk,MAP and SVR were decreased significantly(P<0.05,P< 0.01) and ET was prolonged(P <0.05) in group P.Compared with group S and group M,MAP and SVR of group P declined obviously at T_1,T_2,T_3,T_4(P <0.05).Compared with group M, SVR of group S decreased significantly at T_1,T_2,T_3,T_4(P< 0.05).Conclusion The three kinds of general anesthetics could be used for induction safely and effectively in elderly patients,but propofol has grectest influence on the cardiac function of elderly patients and midazolam has smallest influence.