依托咪酯靶控输注复合舒芬太尼对老年患者全麻诱导气管插管期间血流动力学参数的影响

目的 研究靶控输注不同依托咪酯复合舒芬太尼对老年患者全麻诱导气管插管期间血流动力学的影响。 方法 选择52例全麻下择期手术患者为研究对象,根据依托咪酯的不同靶浓度,随机分为3组:低浓度组血浆靶浓度为0.40 μg/L(17例)、中浓度组为0.50 μg/L(17例)、高浓度组为0.60 μg/L(18例),分别于T0、T1、T2、T3、T4、T5、T6等时点记录患者的MAP、HR、BIS、CO、CI及SV等生理指标,同时计算依托咪酯和舒芬太尼的使用量,最终分析上述指标之间的差异。 结果 ①与T0比较,高浓度组各时点的HR降低但CO和SV升高(P<0.05)。T2时点,3组患者的HR、CO、CI均降低(P<0.05);T3和T4时点,3组CO、CI和SV均升高(P<0.05)。T5时间点,3组的MAP均降低(P<0.05),中、高浓度组的HR、CO、CI和SV均降低(P<0.05)。在T6时间点,3组的MAP均降低(P<0.05)。T3和T4时间点与T2时间点比较,3组的MAP、HR、CO、CI和SV均升高(P<0.05);在T6时间点,高浓度组的MAP、CO、CI和SV均降低(P<0.05);②3组患者诱导期舒芬太尼的平均总使用剂量差异无统计学意义(P<0.05),而依托咪酯3组间差异均有统计学意义(P<0.05)。 结论 老年患者全麻诱导气管插管时对血流动力学参数的影响最小的麻醉方案为依托咪酯靶控输注浓度0.5 μg/L复合舒芬太尼血药浓度0.4 μg/L。 

Influence of target controlled infusion of etomidate and sufentanil on hemodynamic stability during general anesthesia induction and endotracheal intubation in elderly patients

Objective To study the effect of balanced anesthesia with different concentration of chamber etomidate and sufentanil (target controlled infusion,TCI) on hemodynamic stability during general anesthesia induction and endotracheal intubation in elderly patients. Methods Fifty two patients undergoing elective surgery and general anesthesia were enrolled and randomly divided into three groups according to the different target concentration of etomidate:low concentration group (target concentration 0.40 μg/L,17 cases),moderate concentration group (0.50 μg/L,17 cases) and high concentration group (0.60 μg/L,18 cases).The mean arterial pressure (MAP),heart rate (HR),bispectral index (BIS),cardiac output (CO),cardiac index (CI) and stroke volume (SV) were determined at T0(prior to the induction of general anesthesia),T1(chamber and plasma etomidate concentration balanced),T2(chamber and plasma sufentanil concentration balanced),T3(during endotracheal intubation),T4(1 min after intubation),T5(2 min after intubation) and T6(3 min after intubation) time points.The total amount of etomidate and sufentanil were recorded.The data were compared among different groups. Results ①HR decreased while CO and SV increased in the high concentration group at each time points when compared with the data at T0,P<0.05;At T2 point,HR,CO and CI were all decreased in the three groups (P<0.05);At T3 and T4 point,CO,CI and SV were all increased (P<0.05),the value of MAP,HR,CO,CI and SV in all three were higher than those at T2 point (P<0.05);At T5 point,MAP decreased in all three groups (P<0.05),HR,CO,CI and SV decreased only in the medium and high concentration groups (P<0.05);At T6 point,MAP decreased in all three groups (P<0.05),CO,CI and SV decreased only in the high concentration groups (P<0.05);②There was no significant in the average total dose of sufentanil during induction among the three groups (P>0.05),but significant for etomidate. Conclusion The target controlled infusion of 0.50 μg/L of etomidate and 0.4 μg/L of sufentanil will minimize the affection on hemodynamic stability during general anesthesia induction and endotracheal intubation in elderly patients.