舒芬尼、丙泊酚靶控输注麻醉对高龄患者血流动力学和意识的影响

The influense of sufentanil and propofol TCI anesthesia on hemodynamics and consciousness in agedness

目的:观察舒芬尼、丙泊酚靶控输注(TCI)麻醉对65岁以上高龄人群血流动力学、意识和苏醒时间的影响。方法:80例65岁以上老年病人随机分为两组,Ⅰ组为TCI组,Ⅱ组为对照组。Ⅰ组采用舒芬尼TCI0.3ng/ml,丙泊酚TCI4μg/m(l均为效应室浓度)和卡肌宁诱导与维持麻醉,Ⅱ组采用舒芬尼2μg/kg、丙泊酚2mg/kg和卡肌宁诱导,舒芬尼0.1μg(/kg.min)、丙泊酚0.1mg(/kg.min)和卡肌宁维持麻醉并根据血压、心率调节舒芬尼、丙泊酚用量。手术结束前15min两组停用舒芬尼和丙泊酚。记录麻醉前(T0)、气管插管前(T1)、插管后即刻(T2)、插管后5min(T3)、手术开始后(T4)、手术进行1h(T5)、手术结束停舒芬尼和丙泊酚10min后(T6)两组的收缩压(SBP)、舒张压(DBP)、心率(HR)、BIS值和两组停止输注丙泊酚至病人清醒的时间。结果:组内比较:(1)血流动力学:两组T1的SBP和DBP均明显低于T(0P<0.01),T3的SBP均低于T(0P<0.05),Ⅱ组T4的SBP高于T(0P<0.05);两组各时点的HR变化无显著差别(P>0.05)。(2)BIS值:Ⅰ组T1到T5各时点BIS值均明显低于T(0P<0.01),T6BIS值低于T(0P<0.05);Ⅱ组T1到T6各时点BIS值均明显低于T(0P<0.01)。组间比较:(1)血流动力学:Ⅰ组T1的SBP高于Ⅱ组而T4的SBP低于Ⅱ组(P<0.05)。(2)BIS值:Ⅰ组T6的BIS值高于Ⅱ组(P<0.05)。(3)苏醒时间:Ⅰ组停丙泊酚至苏醒时间(LR-S)明显短于Ⅱ组(P<0.01)。结论:舒芬尼、丙泊酚TCI麻醉较传统分次给药和滴注法用于老年人麻醉,在麻醉诱导、术中维持时循环更稳定,术后病人苏醒更快,更安全可靠。

Objective： To consciousness and awake time of sufentanil and propofol TCI anesthesia in agedness over 65 years. Methods： Eighty patients over 65-year-old undergoing abdominal operation were randomly divided into two groups, group Ⅰ was TCI and group Ⅱ was control by traditional intravenous anesthesia. The patients in group Ⅰ were induced and maintained with sufentanil TCI which was set at 0.3 ng/ml, propofol TCI which was set at 4 μg/ml and tracium.The patieuts in group Ⅱ were induced with sufentanil 2 μg/kg, propofol 2mg/kg and tracium and were maintained with sufentanil 0.1 μg/（kg.min）, propofol 0.1 mg/（kg.min） and tracium. To regulate the doses of sufentanil and propofol according to blood pressure and heart rates during the course of the operation in group Ⅱ. Sufentanil and propofol were stopped 15 minutes before the operation was over. The systolic pressure （SBP）, diastolic pressure（DBP）, Heart rate（HR） and BIS were recorded at the time before anesthesia induction（T0）, before intratracheal intubation （T1） ,immediately after intratracheal intubation （T2）, 5 min after intubation tube（T3）,the beginning of operation（T4）,an hour after the beginning of operation （T5）,10 minutes after stopping sufentanil and propofol when the operation was over （T6） and the time from stopping propofol to patients awake in two groups. Results： The Comparison into group：（1）The change of hemodynamics： The DBP and SBP of T1 were obviously lower than that of T0 （P〈0.01） and the SBP of T3 was lower than that of T0 （P〈0.05） in both groups; The SBP of T4 was higher than that of T0 （P〈0.05） in group Ⅱ and the heart rate were no obviously difference each time points in both groups.（2）BIS value：The BIS value from T1 to T5 were obviously lower than that of To （P〈0.01） and that of T6 was lower than that of To （P〈0.05） in group Ⅰ ; The BIS value from T1 to T6 were obviously lower than that of To （P〈0.01） in group Ⅱ .The comparison between group： （1）The change of hemodynamics： The SBP of T1 in group Ⅰ was higher than that in group Ⅱ （P〈0.05） and the SBP of T4 in group Ⅰ was lower than that in group Ⅱ （P〈0.05）.（2）BIS value： The BIS value of T6 in group Ⅰ was higher than that that in group Ⅱ （P〈0.05）.（3）The awake time： The time from stopping propofol to awake in group Ⅰ was obviously shorter than that in group Ⅱ （P〈0.01）. Conclusion： Sufentanil and propofol TCI in agedness have more stable hemodynamics, shorter awake time, and more safety during the anesthesia induction and maintenance.