丙泊酚复合咪达唑仑或氯胺酮用于老年人麻醉诱导的比较  

Effect of ketamine and midazolam as co-induction agents with propofol for anesthesia induction and tracheal intubation in elderly patients

作　　者：罗晨芳[1] 刘德昭[1] 高婉菱[1] 黄品婕[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国老年学杂志》2014年第1期9-11,1644,共3页Chinese Journal of Gerontology

基　　金：广东省卫生厅基金项目(A2009197);广东省科技计划项目(2011B031800058)

摘　　要：目的研究丙泊酚复合咪达唑仑(咪唑安定)或氯胺酮麻醉诱导对老年人插管期血流动力学及苏醒后精神状态的影响。方法行气管插管全麻老年病人40例,随机分成两组:咪唑安定组(M组)和氯胺酮(K组)。麻醉诱导开始时,两组分别静注咪唑安定0.05 mg/kg或氯胺酮0.5 mg/kg,再依次给予同样剂量的丙泊酚、维库溴铵、芬太尼,辅助通气3 min后行气管插管,记录插管前后血压、心率的变化。术后随访病人有无躁动、噩梦等精神方面不良反应。结果两组病人麻醉诱导过程血压、心率组间总的变化比较没有差异(P>0.05),氯胺酮组插管前后的血压、心率变化程度小于咪唑安定组(P<0.05)。M组、K组诱导期出现平均动脉压<60 mmHg分别有4例、1例,均可用麻黄素治疗,组间无差异(P<0.05)。苏醒期两组各有2例,3例患者出现轻度躁动,组间无差异(P<0.05)。术后第1、2天两组患者均无噩梦、幻觉等精神方面不良反应。结论丙泊酚复合氯胺酮较复合咪唑安定在老年患者麻醉诱导插管前、后的血流动力学稳定,且苏醒后无更多躁动、噩梦、幻觉等精神方面不良反应。Objective To observe the effects of ketamine and midazolam as co-induction agents with propofol for anesthesia induc- tion in elderly patients.Methods A prospective,randomized,double-blind,controlled research was conducted in 40 ASA Ⅰ / Ⅱ elderly patients,aged 65 ~ 80 years.Midazolam 0.05 mg / kg and ketamine 0.5 mg / kg were administered in groups M(midazolam) and K(ket- amine) respectively,2 min prior to the administration of the induction dose of propofol.Propofol 1 mg / kg,vecuronium 0.1 mg / kg,fentanyl 3 μg / kg was used for induction,endotracheal tube inserted 3 min later and hemodynamic changes including systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP) and heart rate(HR) were recorded.Agitation,delirium nightmares and hal- lucinations were recorded in recovery period and the next day.Results There were no significant differences in SBP,DBP,MBP and HR between group M and group K(P<0.05).Change magnitude of blood pressure(SBP,DBP,MBP) and HR between pre-and post-intuba- tion in group K were significantly less than those of group M(P<0.05).Four and one patients in group M and group K respectively had MBP less than 60 mmHg during induction.Two and three patients in group M and group K respectively had mild agitation during recovery,but there were no significant differences between them.No delirium nightmares and hallucinations occurred in two groups.Conclusions In elderly patients,the combination of propofol with ketamine produce more stable hemodynamics than with midazolam between pre-and post-in- tubation and don't cause more agitation,delirium nightmares and hallucinations.

关 键 词：氯胺酮 咪达唑仑 丙泊酚 气管插管 血流动力学 

分 类 号：R614[医药卫生—麻醉学]