老年患者靶控输注瑞芬太尼的血流动力学观察

Observation of hemodynamical change of elderly patients with anesthesia of target-controlled infusion(TCI) of remifentanil

目的 观察靶控输注瑞芬太尼时老年患者血流动力学的变化。方法 选择ASA Ⅰ～Ⅱ级行上腹部手术患者60例，按年龄不同分为2组。青壮年组（n=30）30～59岁，老年组（n=30），60～80岁。全麻诱导设定丙泊酚血浆靶控浓度3mg／L，瑞芬太尼7μg／L。意识消失后给予维库溴铵0．1 mg／kg进行气管插管后接麻醉机行机械通气。术中瑞芬太尼靶控浓度维持不变，气管插管后丙泊酚的靶控浓度降至2．5mg／L，术中调节丙泊酚的量使脑电双频谱指数维持在45～55之间。记录麻醉诱导前、麻醉诱导后插管前、插管后1min及插管后5min的SBP、DBP、HR。结果 2组患者间除年龄外，性别、手术种类、体重、术前血球压积与白蛋白浓度及靶控输注时间差异均无显著性，2组患者的丙泊酚、麻黄素及阿托器用量差异有显著性（P＜0．01）。2组患者的SBP、DBP、HR均较诱导前降低，但老年患者更明显（P＜0．01）。结论老年人的药代动力学特征明显不同于青壮年，因此在使用靶控输注瑞芬太尼静脉麻醉时，应根据年龄及种族的不同设定靶控浓度。

Objective To observe hemodynamical change of elderly patients with anesthesia of targe-controlled infusion（TCI） of remifentanil. Methods Sixty patients of ASA classes Ⅰ～Ⅱ ,admitted for upper abdominal surgery,were enrolled and divided into two groups ：the adult group（n=30） and the elderly group（n=30）. Anesthesia induction was induced with TCI of remifentanil and propofol in two groups respectively. Blood target concentration of remifentanil was set at 7 μg/L and propofol was 3 mg/L. When the patients lost consciousness,they were given norcuroium 0. 1 mg/kg and intubated, and mechanical ventilation was maintained in all patients. After intubation,the blood target concentration of remifentanil was kept unchanged and of propo- fol was reduced to 2.5 mg/L. The propofol infusion rate was adjusted to maintain a BIS value between 45 and 55 during surgery. Systolic blood pressure（SBP）,diastolic blood pressure（DBP）and heart rate（HR）were recorded before induction,during intubation, 1 and 5 rain after intubation in all patints. Results The values of SBP ,DBP and HR in both groups were much lower than those before induction,especially in elderly group（P〈0. 01）. Conclusion The pharmacokinetic characteristic of remifentanil in elderly patients differs greatly from that in adult patients. Blood target concentration of remifentanil should be determined according to age and race when TCI remifentanil is used for intravenous anesthesia.