依托咪酯复合不同剂量舒芬太尼在老年颅脑手术麻醉诱导中的应用

目的 探讨依托咪酯复合不同剂量舒芬太尼在老年颅脑手术麻醉诱导中的应用.方法 择期颅脑手术的老年患者60例,年龄60~80岁,根据诱导时舒芬太尼的剂量不同分为2组：Ⅰ组30例,给予舒芬太尼0.3 μg/kg;Ⅱ组30例,给予舒芬太尼0.5 μg/kg.3 min后给予依托咪酯0.2 mg/kg,入睡后罗库溴铵0.8 mg/kg行气管插管.分别记录患者诱导前（T0）、诱导后（T1）、气管插管前（T2）、气管插管即刻（T3）、气管插管后1 min（T4）和气管插管后5 min（T5）时刻的MAP、HR、BIS和SpO2.记录意识消失时间和诱导时间,记录有无呼吸抑制、注射痛、肌阵挛和胸壁僵直等不良反应.结果 两组年龄、体重指数、诱导时间、意识消失时间、各时点BIS值及SpO2差异无统计学意义（P〉0.05）.Ⅰ组和Ⅱ组的MAP和HR在T0和T1时点上无显著变化,而Ⅰ组在T3、T4和T5时点的MAP明显升高,HR增快,与Ⅱ组比较,差异有统计学意义（P〈0.05）.Ⅱ组在T2时点MAP较诱导前明显降低,但与Ⅰ组比较,差异无统计学意义（P〉0.05）,其余各时点的血流动力学变化不明显.结论 舒芬太尼0.5 μg/kg复合依托咪酯更适合用于老年颅脑手术的麻醉诱导.

Application of etomidate with different doses of sufentanyl for neuroanesthesia induction in elderly patients

Objective To investigate the appropriate dosages of sufentanyl with etomidate for neuroanesthesia induction in elderly patients. Methods 60 patients aged 60 - 80 years with elective neurosurgery were randomly divid- ed into two groups according to the different doses of sufentanyl. Group I was given sufentanyl 0. 3 p.g/kg. Group 11 was given sufentanyl 0. 5 μg/kg. Three minutes later, etomidate 0. 2 mg/kg was given intravenously. If the patients reached loss of eyelash reflex, rocuronium 0. 8 mg/kg was given. HR, MAP, BIS, SpO2 changes of patients in the two groups were observed at different time points before induction （TO） , after induction （T1） , before intubation （T2） , the immediately intubation （ T3 ）, after intubation 1 rain （ T4 ） and 5 min （ T5 ） ; as well as the conscious disappearance time, intubation time. The adverse reactions such as respiratory depression, injection pain, myoctonus and chest wall rigidity were also recorded. Results There was no obvious difference between the two groups in age, body mass index, induc- tion time, conscious disappearance time, BIS value. MAP and HR had no apparent change in group Ⅰ and group Ⅱ at TO and T1. However,in group I , HR and MAP at T3, T4 and T5 points increased significantly, the indexes were high-er than those in group Ⅱ （ P 〈 0. 05 ）. MAP in group 1/ at T2 was decreased （ P 〈 0. 05 ）, but no significant difference was found between the two groups （ P 〉 0. 05 ）. MAP and HR in group 11 has no obvious changes at other time points. Conclusion Sufentanyl 0. 5 txg/kg with etomidate is more suitable for neuroanesthesia induction