麻黄碱预处理在老年心功能不全患者全身麻醉中的应用

目的观察麻黄碱预处理在全身麻醉中对老年心功能不全患者的血流动力学的影响。方法选择100例ASAⅡ级、老年Ⅱ级心功能不全非心脏手术患者,随机分成两组,每组50例,观察组予麻黄碱75μg/kg静注2min后,再注射咪达唑仑0.08mg/kg、丙泊酚1mg/kg、芬太尼4μg/kg、维库溴铵0.15ml/kg,3分钟后行气管插管;对照组与上述给药方法和事件相似,仅麻黄碱改为相同容量的0.9%生理盐水。比较两组麻醉诱导期血流动力学变化。记录入室安静≥10min时和气管插管成功后2min彩超监测EF值;记录诱导前(T0基础值)、插管即刻(T1)、插管成功后2min(T2)、4min(T3)、6min(T4)、8min(T5)、10min(T6)七个时间点MAP、HR、SpO2、BIS的数值。结果与同组T0时比较,对照组MAP、HR在T1、T2、T3、T4、T5、T6时间点明显下降(P<0.01),而观察组无明显差异。两组间MAP、HR在T1、T2、T3、T4、T5、T6同时间点比较,对照组明显下降(P<0.01)。两组诱导后较入室时SpO2明显升高(P<0.01),BIS明显降低(P<0.01),但组间比较差异无统计学意义(P>0.05)。入室安静后10min时与气管插管成功后2min比较,对照组EF明显下降(P<0.01)。结论老年Ⅱ级心功能不全患者在麻醉诱导期静脉注射麻黄碱75μg/kg 2min后,再注射麻醉诱导药,可有效地预防低血压、心率减慢的发生,增加围手术期安全性。

The application of Ephedrine in general anaesthesia for elderly people with cardiac dysfunction

Objective To observe the influence of Ephedrine on the hemodynamics of the old people with cardiac dysfunction who have received general anaesthetization for pretreating. Methods Choose 100 patients of ASA Ⅱ or elderly Ⅱ.They had cardiac dysfunction,but they did not undergo heart operation.These patients were randomly divided into two groups with 50 cases in each group.For observation group,2 minutes after the intravenous injection of 75 μg/kg Ephedrine,they were injected 0.08 mg/kg midazolam,1 mg/kg propofol,4 μg/kg fentanyl and 0.15 ml/kg vecuronium.3 minites later,tracheal intubation was performed.Take similar steps for the control group.The only difference was that Ephedrine was replaced by the same quantity of 0.9% normal saline.Hemodynamic changes between these two groups during the anaesthetic induction were compared.Color Doppler ultrasound EF were recorded after the patients calm down since they entered the room for 10 mins or more,and 2 mins after tracheal intubation.Numerical values MAP,HR,SpO2,BIS were recorded at the 7 points：before induction（T0 basic value）,the moment of intubating（T1）,2 min（T2）,4 min（T3）,6 min（T4）,8 min（T5）,10 min（T6）after successful intubation. Results Compared with those at T0 in the same group,MAP and HR of the control group dropped obviously at T1、T2、T3、T4、T5、T6,while the observation group showed no obvious change.Compared with those of the observation group at the same point of T1、T2、T3、T4、T5、T6,the the MAP and HR of control group dropped obviously（P〈0.01）.The SpO2 of both groups after induction raised obviously（P〈0.01） than that before entering the room and the BIS dropped obviously（P〈0.01）.However,there was no significant difference of SpO2 and BIS between groups.Compared with those of observation group,the control group＇s EF（P〈0.01）after the patients calmed down for 10 min and 2 min after intubation drops obviously. Conclusion An intravenous injection of 75 μg/kg Ephedrine and anaesthetic inductive medicine 2mins later,could prevent old people Ⅱ with cardiac dysfunction from low blood pressure and slow heart rate,which will improve the safety of the operation period.