瑞芬太尼复合丙泊酚静脉靶控输注在老年患者脊柱手术中的应用

目的观察瑞芬太尼复合丙泊酚靶控输注(TCI)应用于老年脊柱手术患者的可行性与安全性。方法将80例行脊柱手术患者按年龄分为非老年组(<60岁)和老年组(≥60岁),每组40例。以瑞芬太尼复合丙泊酚TCI诱导和维持,分别记录各时间点药物靶浓度及平均动脉压(MAP)和心率;记录患者从停药至自主呼吸恢复、呼之睁眼、拔管、Aldrete评分达9分的时间。结果与非老年组相比,老年组患者在较低的瑞芬太尼(2.5ng/mlvs.4ng/ml)和丙泊酚[(2.88±0.22)μg/mlvs.(3.05±0.32)μg/ml]靶浓度下即可意识消失,维持过程中瑞芬太尼[(1.45±0.18)ng/mlvs.(2.50±0.21)ng/ml]和丙泊酚[(1.68±0.23)μg/mlvs.(2.66±0.31)μg/ml]靶浓度也明显降低(P<0.01)。老年组患者在停药后自主呼吸恢复[(7.77±0.54)minvs.(7.39±0.61)min]、呼之睁眼[(8.35±0.66)minvs.(7.90±0.58)min]、拔管[(9.30±0.97)minvs.(8.49±0.64)min]、Aldrete达9分[(11.13±0.96)minvs.(9.15±0.69)min]的时间均明显延长(P<0.01)。两组患者从意识消失时点起,除插管后2min时点,各时点的MAP均较基础值有明显降低(P<0.05);各时点的心率也较基础值有明显下降(P<0.05)。结论根据年龄因素个体化调整靶控输注瑞芬太尼复合丙泊酚,可减轻血流动力学波动,维持麻醉深度稳定并减少药物蓄积带来的苏醒延长。

Target controlled infusion of remifentanil and propofol in elderly patients undergoing spinal operation

Objective To observe the efficacy and safety of target controlled infusion(TCI) of remifentanil and propofol in elderly patients undergoing spinal operation.Methods Eighty patients with spinal operation were divided into two groups based on age(the non-elderly group age,whose age were under 60 years old,and the elderly group age,whose age were 60 or above).All patients received remifentanil and propofol for TCI intravenous anesthesia.The average target concentration of remifentanil and propofol was assessed,the hemodynamic data were collected,and the recovery time was recorded in both groups of patients.Results Compared with the non-elderly group,the plasma concentration of propofol [(2.88±0.22)μg/ml vs.(3.05±0.32)μg/ml] and the effect-site concentration of remifentanil when patients loss of consciousness of the elderly group were significantly lower;and patients in the elderly group also required target plasma concentration of propofol [(1.68±0.23)μg/ml vs.(2.66±0.31)μg/ml] and the effect-site concentration of remifentanil [(1.45±0.18)ng/ml vs.(2.50±0.21)ng/ml] were lower during anesthetic maintenanceperiod;and the recovery time was prolonged in the elderly group.Systemic blood pressure decreased significantly in both groups(except T3) after induction but remained stable during the operation.The changes of heart rate were not statistically different at different points or between the two groups.Conclusion Carefully titrating the target remifentanil and propofol concentration could reduce hemodynamic fluctuation while maintain satisfactory anesthesia depth and avoid recovery delay in elderly patients.