曲马多复合丙泊酚对老年患者气管拔管期反应的临床观察

目的 观察曲马多复合丙泊酚对老年患者气管拔管时血流动力学和儿茶酚胺的影响. 方法 选择全麻术毕送PACU的老年患者40例,均为上腹部开腹手术,ASA Ⅰ-Ⅱ级择期全麻手术患者,随机分为观察组和对照组,每组20例.观察组于术毕拔管前给予静脉注射曲马多1.0 mg/kg和丙泊酚0.5 mg/kg;对照组给予10 ml生理盐水静脉缓慢推注,3-5 min后 予吸痰拔管.连续监测观察组和对照组拔管前5 min、拔管即刻、拔管后5 min 3个时点的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及氧饱和度(SpO2)；观察呛咳及恶心呕吐发生情况；同时于拔管即刻及拔管后10 min各采血4ml,检测血浆肾上腺素(E)、去甲肾上腺素(NE)浓度. 结果 对照组拔管时HR、SBP、DBP、MAP显著升高,拔管后5 min仍未恢复到术前水平；观察组拔管时HR、SBP、DBP、MAP较对照组更为平稳；两组各指标比较均差异有统计学意义(P＜0.05).观察组拔管即刻与拔管后10 min E、NE比较无显著性差异；对照组患者拔管后10 min E较拔管即刻明显增高,与观察组比较有统计学差异(P＜0.05),NE拔管即刻与拔管后10 min比较无明显变化,与观察组比较亦无显著性差异.中重度呛咳率观察组发生例数少于对照组(P＜0.05)；两组间恶心、呕吐发生率差异无统计学意义. 结论 老年患者在拔除气管导管前给予曲马多复合丙泊酚能有效预防拔管时老年患者应激反应,且不良反应少.

Effect of tramadol combined with propofol on cardiovascular responses during tracheal extubation in aged patients

Objective To explore the effect of tramadol and propofol on cardiovascular changes during tracheal extubation in aged patients.Methods Forty patients undergoing abdominal operation were randomly and equally divided into observation group and control group.Before tracheal extubation,patients were given intravenously tramadol 1.0 mg/kg and propofol 0.5 mg/kg in observation group,and 10 ml physiological saline in control group.Heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),oxygen saturation(SpO2),and the incidence of nausea,vomiting,agitation were recorded 5 min before extubation,at the tracheal extubation and 5 min after tracheal extubation.Concentrations of norepinephrine(NE) and epinephrine(E) were analyzed at the tracheal extubation and 10 min after extubation.Results At the tracheal extubation,HR,SBP,DBP,MAP increased significantly in control group,while HR,SBP,DBP,MAP kept more stable in observation group than those in control group(P<0.05).Plasma E was significantly higher in control group 10 min after extubation than that before extubation(P<0.05),but NE level had no significant change.Plasma E and NE showed no significant changes in observation group.Plasma E was significantly lower in observation group than in control group 10 min after extubation(P<0.05).The incidence of nausea and vomiting in observation group was lower than in control group,but there was no statistical difference between two groups(P>0.05). Conclusion The small doses of tramadol and propofol in the aged patients can effectively prevent the tracheal extubation-induced cardiovascular responses with few adverse reactions.