丙泊酚-七氟醚复合诱导在老年人麻醉中的临床观察

目的:探讨丙泊酚-七氟醚复合诱导对血流动力学及应激反应的影响,为老年人麻醉提供一个更好的麻醉诱导选择。方法:择期胆囊、胃肠手术的老年患者60例,美国麻醉师协会(ASA)标准Ⅰ～Ⅱ级,年龄60～75岁,随机分为A组(丙泊酚)、B组(七氟醚)、C组(丙泊酚-七氟醚复合),各20例。患者入室5min后记录血压(BP)、心率(HR)、血糖作为基础值(T0),记录插管前即刻(T1),插管后即刻(T2),插管后1min(T3)、3min(T4)、5min(T5)、7min(T6)时BP、HR、血糖的变化。结果:B组有15%患者(3/20)主诉吸入气体有异味,不肯接受,需辅助其他静脉麻醉药完成麻醉诱导。与基础值比较,3组诱导后HR较诱导前降低(P<0.01),气管插管后即刻A、B、C组HR加快,其中以A、B组加快明显。与基础值比较,气管内插管前3组患者的SBP、DBP、MAP均降低,其中降低程度A、B组>C组(P<0.01),A、B组与C组比较差异有统计学意义。气管插管后即刻,3组患者血压明显上升,插管后1～2min达高峰,随后逐渐回到插管前水平。与基础值比较,T4、T6时3组血糖均降低(P<0.05),其中降低程度B、C组>A组(P<0.01)。结论:丙泊酚-七氟醚复合诱导可以增强药效,减少单一麻醉药的用量,对血流动力学干扰小,气管插管时应激反应小,更适合老年人的麻醉诱导。

Clinical Observation of Anesthesia Induction Effects of Propofol Combined with Sevoflurance in Elderly Patients

OBJECTIVE：To investigate the effect of propofol combined with sevoflurance on hemodynamics and stress reaction in the elderly patients,and to provide an anesthesia induction method for elderly patients.METHODS：60 ASA（Ⅰ～Ⅱ） patients undergoing selective cholecystic or gastrointestinal surgery,aged 60～75,were randomized into 3 groups （n=20）：anesthesia induced with propofol （group A）,sevoflurance （group B） and propofol combined with sevoflurance （group C）.The levels of BP,HR and blood glucose were recorded at the time of inter-room as baseline value （T0）,the moment of before intubation （T1） and after intubation （T2）,1 min （T3）,3 min（T4）,5 min（T5） and 7 min （T6） after intubation.RESULTS：15% of patients in group B failed to finish anesthesia induction for the smelling.HR in 3 groups was decreased after induction as compared with the baseline values （P0.01）.But at the moment of tracheal intubation,HR of group A,B and C were significantly increased than before,especially in group A and B.Before tracheal intubation,SBP,DBP and MAP of 3 groups were decreased as compared with baseline value.The decrease of group A and B was more significant than group C （P0.01）,there was statistical significance.At the moment of tracheal intubation,BP of 3 groups were increased significantly and reached the peak value 1～2 min after intubation.Then,BP returned to the pre-tracheal intubation level gradually.Blood glucose levels of 3 groups were decreased at T4 and T6 （P0.05）,the decreases of group B and C were more significant than that of group A （P0.01）,there was statistical significance.CONCLUSION：Inhalation of propofol combined with sevoflurance can enhance medical efficacy and reduce the amount of single anaesthetic.It leads to less variation in hemodynamics and stress reaction during general anesthesia induction.It is a better option for anesthesia induction to the elderly patients.