小剂量肾上腺素和麻黄碱对老年患者顺式阿曲库铵起效时间及血流动力学的影响  

Effects of low dose epinephrine and ephedrine on cisatracurium onset time and hemodynamics during anesthesia induction in elderly patients

作　　者：陈长宝[1] 王爱忠[2] 江伟[2] 

机构地区：[1]苏州大学,2151231 [2]上海交通大学附属第六人民医院麻醉科

出　　处：《上海医学》2011年第2期93-96,共4页Shanghai Medical Journal

摘　　要：目的观察小剂量肾上腺素和麻黄碱对老年患者全身麻醉诱导期顺式阿曲库铵起效时间和血流动力学的影响。方法 75例择期在全身麻醉下行膝关节或髋关节置换术的老年患者,随机分为肾上腺素组、麻黄碱组和对照组,每组25例,在芬太尼和丙泊酚诱导后,分别予肾上腺素0.06μg/kg、麻黄碱70μg/kg或0.9%氯化钠溶液5mL,然后静脉注射顺式阿曲库铵0.15mg/kg。记录肌松起效时间及气管插管评级,监测心排量、血压和心率的变化。结果 肾上腺素组和麻黄碱组的顺式阿曲库铵的起效时间均显著短于对照组(P值分别<0.01、0.05),气管插管评级均显著优于对照组(P值均<0.05)。与本组基础值比较,麻醉诱导后对照组的心排量和血压显著下降(P值分别<0.05、0.01);麻醉诱导后肾上腺素组和麻黄碱组的血压显著下降(P值分别<0.05、0.01),但心排量无明显变化(P值均>0.05)。麻醉诱导后肾上腺素组和麻黄碱组的血压和心排量显著高于对照组(P值分别<0.05、0.01),麻黄碱组的平均动脉压显著高于肾上腺素组(P值均<0.05)。气管插管后麻黄碱组的血压仍显著高于对照组和肾上腺素组(P值分别<0.05、0.01)。麻醉诱导后气管插管前即刻3组的心率均较本组基础值显著下降(P值分别<0.01、0.05),但3组间的差异无统计学意义(P值均>0.05)。结论 0.06μg/kg肾上腺素和70μg/kg麻黄碱都可缓解老年患者全身麻醉诱导时的循环抑制,缩短顺式阿曲库铵的起效时间,改善气管插管条件。肾上腺素作用短暂,不会加剧气管插管所致的高血压,因而更适合老年患者。Objective To observe the effects of low dose epinephrine and ephedrine on the onset of cisatracurium and the hemodynamics during the induction of anesthesia in elderly patients.Methods Seventy-five elderly patients undergoing knee or hip replacement under general anesthesia were randomly assigned to three groups（n=25）：Epinephrine group,Ephedrine group and Control group.After the induction of anesthesia with fentanyl and propofol,the patients were randomly assigned to receive either 0.06 μg/kg of epinephrine,70 μg/kg of ephedrine or a saline placebo,and then 0.15 mg/kg of cisatracurium was administered.The onset time of cisatracurium and the intubation condition were observed.The cardiac output,the invasive blood pressure and the heart rate were also observed.Results The cisatracurium onset time intervals in Epinephrine group and Ephedrine group were significantly shorter than those in the Control group（P0.01,0.05,respectively）,and the intubation conditions were significantly better than that in the Control group（P0.05）.Compared with the baseline level,the cardiac output and blood pressure after induction were significantly decreased in the Control group（P0.05,0.01,respectively）and the blood pressure was significantly decreased in the Epinephrine group and Ephedrine group（P0.05,0.01,respectively）;there was no significant changes in the cardiac output（P0.05）.The blood pressure and cardiac output in Epinephrine group and Ephedrine group were significantly higher than those in the Control group（P0.05,0.01,respectively）and the mean arterial pressure in Ephedrine group was significantly higher than that in Epinephrine group（P0.05）.The blood pressure in the Ephedrine group was significantly higher than those in the Epinephrine group and Control group（P0.05,0.01,respectively）after intubation.Compared with the baseline,the hear rate was significantly decreased before intubation in the three groups（P0.01,0.05,respectively）,and there were no significant differences among the three

关 键 词：肾上腺素 麻黄碱 顺式阿曲库铵 起效时间 血流动力学 

分 类 号：R614[医药卫生—麻醉学]