异丙酚复合芬太尼麻醉在老年患者门诊手术的应用  

Use of propofol combined with fentanyl in elderly patients for outpatient clinic operation

作　　者：葛东明[1] 张俊峰[1] 张晓丽[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,200233

出　　处：《上海医学》2005年第11期942-944,共3页Shanghai Medical Journal

摘　　要：目的评价异丙酚复合芬太尼麻醉在老年患者门诊手术中的应用效果及可行性.方法美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行泌尿外科门诊手术的老年患者56例,年龄65～93岁.予芬太尼1.0～1.5μg/kg和异丙酚60 mg·kg-1·h-1诱导,意识消失后予异丙酚3～6 mg·kg-1·h-1麻醉维持.记录注药前及注药后2、5、10、20、60 min时收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2)的变化.记录异丙酚诱导剂量、停药后睁眼时间、指令握拳时间.观察术后情绪变化和记忆情况、视觉模拟(VAS)评分及不良反应发生情况.结果出现呼吸暂停的25例患者的异丙酚诱导剂量为(71士13)mg,明显大于31例未出现呼吸暂停者的(56±11)mg(P＜0.05).静脉注射异丙酚后患者的SBP、MAP、SpO2显著下降(P＜0.05),但下降幅度在正常范围内,20 min内恢复至基础水平(P＞0.05).注药前、后DBP、HR无显著变化(P＞0.05).停药后意识恢复时间为(5±1)min,指令握拳时间为(8±2)min.患者术后情绪均稳定,无术中记忆,96%的患者VAS评分为0,8%,术后嗜睡,6%出现恶心.结论异丙酚复合芬太尼麻醉可有效应用于老年患者的门诊手术,但应注意选择合适剂量和注药速度,以避免对呼吸、循环功能的抑制.Objective To evaluate the efficacy and feasibility of propofol combined with fentanyl in elderly patients for outpatient clinic operation. Methods Fifty-six ASA Ⅰ-Ⅱ elderly patients in the outpatient clinic were studied. Anesthesia was induced with fentanyl 1.0～1.5μg/kg and propofol 60mg·kg^-1·h^-1 , following maintenance with propofol 3-6mg·kg^-1·h^-1. The SBP, DBP, MAP, HR and SpO2 were recorded before and 2, 5, 10, 20, 60 min after injection of the anesthetics. The dosage of propofol for induction and the time for emergence after stopping the infusion of propofol were also recorded. The patientsremotion, visual analogue scale （VAS） and side effects were observed after the operation. Results The dosage of propofol for induction of 25 patients with apnea was significantly larger than that of the other 31 patients without apnea. SBP, MAP, SpO2 decreased after injection of propofol （P 〈0.05） and recovered to baseline after 20 min, but the decrement extent was within normal range. There was no significant changes of DBP, HR after injection of propofol. The time for emergence and hand grasping following verbal commands were （5±1） min and （8±2） min, respectively. The VAS of 96% patients was 0, with 8% hypersomnia, 6% nausea. Conclusions Propofol in combination with fentanyl show effective response in the elderly patients during the operation in outpatient clinic, but the proper dosage and the infusion rate of propofol should be individualized to avoid cardiorespiratory depression.

关 键 词：异丙酚 芬太尼 老年患者 门诊手术 

分 类 号：R614[医药卫生—麻醉学]