吸入七氟醚诱导插管在老年患者中的应用

目的评价吸入七氟醚诱导插管用于老年人的有效性和安全性。方法选择40例且美国麻醉医师协会（ASA）评级Ⅰ-Ⅱ级的全身麻醉下择期行腹部手术的65～75岁患者,随机分为两组。吸入诱导组表面麻醉后仅吸入8%七氟醚诱导,静脉诱导组按常规剂量先后依次快速注入咪唑安定、丙泊酚、舒芬太尼及维库溴铵,待麻醉深度适当时行气管插管。结果吸入诱导组意识消失平均时间接近静脉诱导组,脑电双频指数（BIS值）下降不如静脉诱导组明显（P〈0.05）;两组诱导插管平均时间约5min（P〉0.05）,插管条件均可接受,但吸入诱导组插管条件达到非常好者仅占60.00%,显著低于静脉诱导组（P〈0.05）,而一次插管成功率两组无显著性差异。吸入诱导组平均动脉压下降率明显小于静脉诱导组（P〈0.05）,心率变化趋势上两组无统计学差异;吸入诱导组插管前呼吸未完全抑制者8例,给予插管后该组其余患者均恢复自主呼吸;两组诱导插管前未出现严重不良反应。结论不联合肌松剂吸入8%七氟醚,可安全有效地用于老年患者的麻醉诱导插管。

Anesthesia Induction and Endotracheal Intubation with Inhalation Sevoflurane in Elderly Patients

Objective To estimate the efficiency and safety of induction and endotracheal intubation with inhalation sevoflurane in elderly patients,compared with routine intravenous（IV） anesthesia induction.Methods Forty elderly patients with aged 65-75 years and ASA physical status Ⅰ-Ⅱ undergoing selective abdominal operations were allocated randomly to the inhalation induction group（group Ⅰ） with inhalation 8% sevoflurane alone after surface anesthesia or the intravenous induction group（group Ⅱ）,in which the patients were orderly bolus injected with midazolm,propofol,sulfentanly and vecuronium as a routine dose.The trachea was intubated if the depth of anesthesia was adequate possibly.Then HR,MAP,SpO2,BIS value,end-tidal concentration of sevoflurane were recorded every minute until 5 min after intubation.Also the time to loss of consciousness（LOC）,the induction-intubation time,assessment of intubation conditions,frequency of successful intubation for the first attempt and adverse events were documented.Results The average time to LOC in the group Ⅰ was close to that in group Ⅱ.The BIS decrease was significantly lower in group Ⅱ than group Ⅰ（P〈 0.05）.The average induction-intubation time was approximately 5 min,which was not significantly different in both groups.The assessment of intubation conditions were considered as acceptable in both groups.However,60.00% in the group Ⅰ were judged to have excellent intubation conditions,significantly differed with the group Ⅱ（P〈 0.05）.There was no significant difference with respect to successful intubation for the first attempt in the groups.The percentage decrease in MAP compared with baseline in group Ⅱ during induction was significantly lower than that in the group Ⅰ（P〈 0.05）.No significant difference was observed in the change of HR in both groups.There were 8 patients keeping weak breathing before intubation in the group Ⅰ,and the rest recovered spontaneously respiration after intubation.No serious adverse events occurred before intubation in both groups.Conclusion Induction anesthesia with 8% sevoflurane inhalation without adding muscle relaxant is an acceptable alternative to routine IV induction for the elderly patients.