摘要
目的探讨七氟醚和依托咪酯用于麻醉诱导时对老年腹部手术患者心血管系统的影响。方法40例ASAⅠ-Ⅱ级择期行腹部手术老年患者，随机分成七氟醚组（S组）和依托咪酯组（E组），各20例，全麻诱导均采用咪达挫仑0．03mg／kg、芬太尼3μg／kg、顺苯阿曲库氨0．2mg／kg，在此基础上S组用6％的七氟醚，E组用0．3mg／kg完成麻醉诱导。记录5个时间点（T0为入手术室时，T1为插管即刻，T2为插管后1、2、3min，T3为插管后5min，T4为插管后10min）的血流动力学指标（DBP、SBP、HR），T0、T1、T2时间点自主神经活动指标（IF，HF，IF／HF），以及激素水平变化指标（Aid，ACTH，Cor）。结果两组T0和T1时点SBP、DBP均呈下降趋势，而HR略上升，T2时点E组SBP、DBP、HR较T1时点分别上升36％、70％、30％，较T0时点分别升高11％、29％、44％，差异均有统计学意义（P〈0．05），而S组与T0时点基本持平；两组T3、T4时点差异均无统计学意义。两组T0、T1时点LF、HF、LF／HF差异均无统计学意义，同一组患者二时间点相比LF、HF均为2％左右的小幅度波动；T2时点两组3项指标均差异有统计学意义（P〈0．05），E组LF、HF、LF／HF较T1时点分别上升24％、下降11％、上升41％，S组分别上升6％、下降1％、上升7％。两组T0时点Cor、ACTH、Aid血液浓度差异均无统计学意义，T1、T2时点差异有统计学意义（P〈0．05），E组Cor水平T2时点较T0时点下降35％、ACTH上升46％、Ald下降34％，而S组Cor上升7％、ACTH上升16％、Ald上升4％。结论单纯依托咪酯复合其他麻醉基础药并不能有效抑制插管刺激引起的应激刺激，特别是对老年人的收缩压、心率有较大影响；七氟醚对抑制有害刺激和保持血流动力学稳定性有一定优势。
Objective To discuss the impact of the induction of anaesthesia by using sevoflurane or etomidate to the elderly patients, cardiovascular system who were undergoing abdominal operations.Methods 40 cases of selected elderly patients with abdominal operations, ASA Ⅰ-Ⅱ level, were randomly divided into two groups： Etomidate group （ group E, n=20 ） , Sevoflurane group （ group S, n=20 ） .The induction of anesthesia are as follows： Two groups were in turn injected midazolam 0.03mg/kg, fentanyl 3μg/kg, etomidate 0.3mg/kg or inhaled sevoflurane 6%. cisatracurium besilate 0.2mg/kg.Recording the hemodynamic parameters of two groups： DBP, SBP, HR at 5 moments （ To, T1, T2, T3, T4 ） ; autonomic nerve activity index： IF, HF, IF/HF at 3 moments （ T0, T1, T2 ） ; changes of hormone levels： Ald.ACTH, Cot at T0, TI, T2. Resluts Hemodynamic parameters： The SBP, DBP of two groups were in a small downtrend at T0, T1.HR rose little.It has no statistical significance （ P〉0.05 ） .The SBP, DBP, HR of group E at T2 increased by 36%, 70%, 30% compared with TI, and increased by 11%, 29%, 44% compared with T2, group S were at the level ofT0 It had no statistical significance （ P〉0.05 ） at T3 and T4. Autonomic nerve activity index： LF, HF, LF/HF had no statistical significance between two groups at TO and T1 （ P〉0.05 ） , but a small amplitude fluctuation about 2%.At T2 there is a statistical significance between two groups.The LF, LF/ EF of group E compared T1 increased by 24%, 41%, HF decreased by 11%.The same index of group S increased by 6%, 7%, decreased by 7%. Changes of hormone levels： Cor, ACTH, Aid had no statistical significance （ P〉0.05 ） at To, but at T1 it is opposite. At T2 Cor, Ald of group E decreased by 35%, 34%, ACTH increased by 46%. Cor, ACTH, Ald increased by 7%, 16%, 4%. Conclusion . Only etomidate combined other narcotic basal medicine can not inhibit the stress induced by intubation, especially it has a great influence on systolic pressure and heart rate. which is detrimental to the organ blood supply, and much easier leading to cardiovascular and cerebrovascular accident. Sevoflurane has a certain advantage of inhibiting noxious stimulation and keeping hemodynamic stability, can be further attempted in abdominal operation of the old.
出处
《浙江临床医学》
2014年第2期208-211,共4页
Zhejiang Clinical Medical Journal
关键词
七氟醚依托咪酯
老年
腹部手术
心血管系统
Sevoflurane Etomidate Senium Abdominal operation Cardio -vascular system
