摘要
目的比较不同剂量瑞芬太尼配伍依托咪酯静脉麻醉对老年患者围手术期血糖的影响,从而观察其对患者应激反应的影响。方法选择手术治疗接受气管插管全麻的老年患者120例,ASAⅠ或Ⅱ级。测手术前、麻醉1h后、及清醒后血糖值,不用术前药,依诱导及麻醉中瑞芬太尼不同用量随机分为4组(n=30),瑞芬太尼诱导用量分别是5μg/kg(A组)、10μg/kg(B组)、15μg/kg(C组)、20μg/kg(D组);依托咪酯(0.3mg/kg)、维库溴胺(0.1mg/kg)用量4组相同;A组诱导不用阿托品,其他3组静注阿托品0.008mg/kg。依托咪酯、瑞芬太尼同时泵注(时间6min),泵注1min后静注阿托品(静注时间10s),意识消失后静注维库溴胺。泵注结束后气管插管。结果 B组、C组、D组插管前血糖比基础值降低率明显高于A组,且差异有统计学意义(P<0.05);C组、D组插管1h后血糖比插管前降低率明显高于A组和B组,且差异有统计学意义(P<0.05);C组、D组插管1h后HR比插管前降低率明显低于A组,且差异有统计学意义(P<0.05)。结论与依托咪酯0.3mg/kg配伍诱导气管插管,瑞芬太尼15μg/kg用量抑制应激反应效果达A级,增加瑞芬太尼用量到20μg/kg,抑制应激反应效果没有进一步明显增强。
Objective To observe patients＇ stress reaction by comparing the effect of different dosage of remifentanil and etomidate intravenous anesthesia in perioperative blood glucose of the elderly. Methods 120 elder patients who received tracheal intubation general anesthesia in selection stage with ASA Ⅰ or Ⅱ were selected. Blood glucose level before surgery, lh after anesthesia and after sobering up were tested. 120 patients were randomly allocated into four groups （n--30） according different dosage of remifentanil in induction and anesthesia without pre-operative medication. Dosage of remifentanil induction was 5μg/kg（A group）. 10 μ g/kg （B group）, 15μg/kg（C group）, and 20 μ g/kg（D group） respectively. The dosage of etomidate （0.3mg/kg）and vecuronium bromide （0. lmg/kg） was same in four groups. A group was not inducted with atropine, and other three groups were intravenous injected with atropine 0.008mg/kg. Etomidate and remifentanil were pumped in for 6 minutes, and atropine was intravenous injected for 10 seconds after 1 minute＇s pumping. Vecuronium bromide was intravenous injected after loss of consciousness..Tracheal intubation was carried out after pumping in. Results The reduction rate of blood glucose before tracheal intubation in B group, C group and D group was significantly higher than that in A group comparing with basic value, and the difference was statistically significant （P 〈 0.05）. The reduction rate of blood glucose lh after tracheal intubation in C group and D group was significantly higher than tha! in A group and B group comparing with that before tracheal intubation, and the difference was statistically significant （P 〈 0.05）. Conclusion The effect of 15 Ix g/kg dosage of remifentanil in suppressing stress response reaches to A level, combing with 0.3mg/kg etomidate while inducing tracheal intubation. The effect of suppressing stress response is not further improved by increasing the dosage of remifentanil to 20ug/kg.
出处
《中国医药科学》
2015年第13期159-161,共3页
China Medicine And Pharmacy
关键词
瑞芬太尼
依托咪酯
血糖
应激反应
Remifentanil
Etomidate
Blood glucose
Stress response
