依托咪酯两种靶控模式用于老年患者诱导期的血流动力学比较  

Comparison of hemodynamics of elderly patients during general anesthesia induction with two kinds of Etomidate target controlled infusion

作　　者：夏丰娜 杜伟[2] 杜平均 王红[1] 张笑然[1] 王月兰[1] 薛娟[1] 

机构地区：[1]河北省第七人民医院麻醉科,河北定州073000 [2]河北医科大学第四医院麻醉科,河北石家庄050011

出　　处：《中国医药导报》2017年第19期62-64,76,共4页China Medical Herald

基　　金：河北省卫生计生委指导项目(20150548)

摘　　要：目的探讨不同靶控输注模式输注依托咪酯对老年患者全麻诱导插管过程中血流动力学的影响。方法选择河北省第七人民医院2015年4~6月择期行气管插管全麻手术的老年患者40例,随机分为两组,血浆浓度靶控输注组P,效应室靶控输注组E,各20例。比较两组患者靶控输注开始(T_0)、睫毛反射消失时(T_1)、效应室浓度和血浆浓度平衡时(T_2)、气管插管时(T_3)、插管后1 min(T_4)、插管后2 min(T_5)的平均动脉压(MAP)、心率(HR)、心输出量(CO)、每搏量(SV)、BIS值的变化,记录从靶控输注开始至睫毛反射消失时间、气管插管完成时间及各时点依托咪酯使用总量。结果与T_0比较,两组T_(2~5)时刻MAP、CO、SV、BIS水平均下降,差异有统计学意义(P<0.05);两组T_(1~3)时刻MAP、CO、SV水平差异有统计学意义(P<0.05);两组各时点HR、BIS水平差异无统计学意义(P>0.05)。E组睫毛反射消失时间和气管插管完成时间明显短于P组,差异有统计学意义(P<0.05)。睫毛反射消失时和气管插管完成时依托咪酯用药总量两组差异无统计学意义(P>0.05)。结论采用血浆浓度靶控输注方式输注依托咪酯进行麻醉诱导有利于老年患者血流动力学稳定。Objective To compare the effect of general anesthesia induction with different kinds of Etomidate target controlled infusion on hemodynamic of elderly patients. Methods 40 cases of elderly patients underwent selective gen- eral anesthesia surgery were enrolled in this study from April to June 2015 in the Seventh People＇s Hospital of Hebei Province. All patients were randomly divided into two groups, each group had 20 cases. Group P was given plasma con- centration target controlled infusion, and group E was given effect-site target controlled infusion. The mean arterial pressure （MAP）, heart rate （HR）, cardiac output （CO）, stroke volum （SV）, bispectral index （BIS） and the were recorded and compared immediately at To （before induction）, Tj （loss of eyelash reflex）, T2 （etomidate plasma and effect-site con- centration reached a balance）, T3 （intubation）, T4 （1 min after intubation ）, T5 （2 min after intubation）. The time when eyelash reflex disappered and intubation completed, and dosages of etomidate were recorded. Results Compared with To, at T2-5 the levels of MAP, CO, SV, BIS were dereased in the two group, with statistically significant differences （P 〈 0.05）. At T1-3, there were statistically significant differences in MAP, CO, SV between the two groups （P 〈 0.05）, but the levels of HR and BIS had no statistically significant differences （P 〉 0.05）. Compared with group P, the time of eyelash reflex disappearing and intubation was shorter in group E （P 〈 0.05）. There were no statistically significant differences in the dosages of Etomidate using at eyelash reflex disappearing time and intubation time between group E and group P （P 〉 0.05）. Conclusion Adopting plasma concentration target controlled infusion for elderly patients during general anesthesia induction can help maintain stable hemodynamics.

关 键 词：依托咪酯 靶控输注 老年患者 诱导期 

分 类 号：R614.2[医药卫生—麻醉学]