丙泊酚依托咪酯混合剂麻醉对老年患者血流动力学及血清皮质醇的影响  

Effects of Propofol and Etomidate on Hemodynamics and Serum Cortisol in Elderly Patients under General Anesthesia

作　　者：周维纲[1] 杨建治 陶维初 柏巍松[1] 郑名辉 杨瑞[2] ZHOU Weigang;YANG Jianzhi;TAO Weichu;BAI Weisong;ZHENG Minghui;YANG Rui(Hanzhong Central Hospital, Hanzhong Shaanxi 723000 , China)

机构地区：[1]汉中市中心医院,陕西汉中723000 [2]陕西省人民医院

出　　处：《解放军预防医学杂志》2018年第12期1535-1538,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：汉中市中心医院院级科研基金项目(No.YK17016)

摘　　要：目的评价丙泊酚依托咪酯混合剂在老年麻醉中血流动力学的稳定性及对血清皮质醇的影响。方法纳入择期行消化系统肿瘤切除术患者40例,性别不限,年龄50～70岁,ASAⅠ～Ⅲ级,随机分为丙泊酚组(P组,n=20)和丙泊酚依托咪酯混合剂组(YP组,n=20)。记录患者年龄、性别、体质量、手术时间、术中血管活性药使用次数等基本资料。详细记录血流动力学参数,并依次计算出患者围术期收缩压变异系数、舒张压变异系数和心率变异系数。分别于手术当天(T0)、术后1天(T1)和术后3天(T2)测量患者血清皮质醇水平。结果与P组相比,YP组患者围术期收缩压变异系数明显降低(P<0.05); YP组患者围术期舒张压变异系数也明显低于P组(P<0.05); YP组心率变异系数差异无统计学差异(P>0.05); P组患者围术期血管活性药使用比率明显升高(P<0.05)。与两组T0时血清皮质醇水平相比,P组T1、T2血清皮质醇水平明显升高(P<0.05); YP组T1血清皮质醇水平明显降低(P<0.05),T2血清皮质醇明显升高(P<0.05)。结论丙泊酚依托咪酯混合剂持续泵注可以使老年患者围术期血流动力学更加平稳,皮质醇抑制作用术后1天可基本恢复正常,可安全应用于老年麻醉。Objective To evaluate the effect of propofol and etomidate on hemodynamic stability and serum cortisol in elderly patients with general anesthesia.Methods A total of 40 patients with digestive system tumor resection,of both sexs,aged 50 to 70,and of physical status Ⅰ or Ⅲ by American Society of Anesthesiologists were randomly divided into two groups: propofol group( group P,n = 20),and etomidate plus propofol group( group YP,n = 20).The basic data on age,gender,weight,duration of surgery and number of times intraoperative vasoactive agents were used was collected.Hemodynamic parameters were recorded in detail,and the coefficients of variation of systolic pressure,diastolic pressure and heart rate during the perioperative period were calculated.Serum cortisol levels were measured on the day of surgery( T0),1 day after surgery( T1) and 3 days after surgery( T2),respectively.Results Compared with group P,the coefficient of variation of perioperative systolic blood pressure in group YP was significantly decreased( P<0.05),and that of perioperative diastolic blood pressure in group YP was also significantly lower than in group P( P < 0. 05). There was no significant change in the variation coefficient of heart rate in group YP( P>0.05).The amount of vasoactive agents used perioperatively was significantly increased in group P( P<0.05).Serum cortisol levels of T1 and T2 in group P were significantly higher( P<0.05).Serum cortisol levels of T1 in group YP were significantly decreased( P<0.05),while those of T2 were significantly increased( P<0.05). Conclusion Continuous pump injection of etomidate plus propofol can help stabilize the perioperative hemodynamics of elderly patients and can thus be safely applied to senile anesthesia.

关 键 词：丙泊酚 依托咪酯 老年麻醉 

分 类 号：R614[医药卫生—麻醉学]