去甲肾上腺素联合酒石酸布托啡诺在老年高血压患者快诱导中的应用观察

目的 讨论丙泊酚快诱导期间持续泵注去甲肾上腺素复合酒石酸布托啡诺注射液（以下简称“诺扬”）对老年高血压患者宏观循环及微观灌注的影响。方法 择期上腹部手术的老年高血压患者60例,年龄65岁以上,ASA II-Ⅲ级,随机分为3组：去甲肾上腺素组（Ⅰ组）、生理盐水+诺扬组（Ⅱ组）、去甲肾上腺素+诺扬组（Ⅲ组）;其中Ⅰ组和Ⅲ组诱导期间持续泵入去甲肾上腺素（调节泵入速率、维持平均动脉压（MAP）在60~130 mmHg）,而Ⅱ组和Ⅲ组则在使用丙泊酚诱导2 min前以诺扬0.02 mg/kg iv. 三组均以丙泊酚2.5~3.5 μg/mL TCI、舒芬太尼0.4 μg/kg及顺式阿曲库铵0.2 mg/kg静注快速诱导,3 min后行气管插管并机械通气。记录各组诱导前（T₀）、诱导后（T₁）、插管前（T₂）、插管后（T₃）及手术开始前（T₄）的MAP和心率（HR）,并于T₀、T₃、T₄时刻采集桡动脉血2 mL行血气分析,测定血糖（cGlu）及乳酸（cLac）的值。结果 三组患者基础血压、心率等无统计学差异（P>0.05）;与Ⅰ组相比,Ⅱ、Ⅲ组患者诱导时注射痛、呛咳及肌颤搐的发生率较低（P<0.05）;与T₀时刻相比,三组诱导后MAP、HR均较前降低。而与Ⅱ组相比,Ⅰ组和Ⅲ组在T₁、T₂、T₃时刻MAP波动更小（P<0.05）;与T₀时刻相比,Ⅲ组在T₄时刻乳酸值改善最明显,与其他两组相比差异有统计学意义（P<0.05）;而同时刻相比,各组血糖值无显著差异（P>0.05）。结论 去甲肾上腺素复合诺扬能更好地预防老年高血压患者快诱导期间宏观血压波动并改善其微观灌注,减少呛咳等不良反应,对稳定该类患者血流动力学有较好的效果及安全性。

Application of norepinephrine combined with butorphanol tartrate in the rapid induction of elderly patients with hypertension

Objective To investigate the effects of norepinephrine combined with butorphanol tartrate on the macrocirculation and microperfusion in elderly patients with hypertension during rapid induction of propofol. Methods Sixty elderly patients with hypertension who underwent elective upper abdominal surgery, age 65~79 years, ASAⅡ~Ⅲ, were randomly divided into 3 groups： Norepinephrine （groupⅠ）, saline + butorphanoltartrate （groupⅡ） and norepinephrine + butorphanoltartrate （group Ⅲ）. Norepinephrine was continuously pumped in groupⅠand group Ⅲ during induction and maintained the MAP within 60-130 mmHg, while in group Ⅱ and groupⅢ, butorphanoltartrate 0.02 mg/kg iv was administered two minutes before induction. All groups were induced by propofol 2.5~3.5 μg/mL TCI, sufentanil 0.4 μg/kg iv and homeopathic atracurium 0.2 mg/kg iv. And after 3 min, tracheal intubation and mechanical ventilation were performed. The MAP and HR of each group before induction （T₀）, after induction （T₁）, before intubation （T₂）, after intubation （T₃）, and before surgery （T₄） were recorded, and at the moment of T₀, T₃ as well as T₄, blood gas analysis was performed to measure the values of blood glucose （cGlu） and lactic acid （cLac）. Results Compared with group I, the incidence of injection pain, cough and muscle twitch was lower in groupⅡand group Ⅲ （P<0.05）. Compared with T₀, MAP and HR in all three groups were lower after induction. Compared with group Ⅱ, the MAP fluctuations were smaller in groupⅠand group Ⅲ （P<0.05）. Compared with T₀, lactic acid level in group Ⅲ at T4 was the most significantly improved, and the difference was statistically significant compared with the other two groups （P<0.05）. As well, there was no significant difference in blood glucose in each group （P>0.05）. Conclusion Norepinephrine combined with butorphanol tartrate can greatly prevent macrocirculation fluctuation, improve microscopic perfusionduring rapid induction, reduce cough and other adverse reactions in elderly hypertensive patients.