硬膜外麻醉下丙泊酚靶控输注镇静在老年患者中的应用

Target-controlled infusion with propofol for sedation in elderly patients undergoing epidural anesthesia

目的:评估老年患者在硬膜外麻醉下使用丙泊酚靶控输注镇静的效果。方法:选择ASAⅠ～Ⅱ级,硬膜外麻醉下行下肢手术的患者,按年龄分为两组:老年组(65～80岁)20例,非老年组(18～55岁)20例。待麻醉平面、效果和血液动力学平稳后,予以丙泊酚靶控输注镇静,设定镇静水平为警觉/镇静(OAA/S)评分3分,观察镇静前与OAA/S评分3分时患者血液动力学的变化、靶控浓度、丙泊酚的累积量和需要的时间。结果:在OAA/S评分3分时,两组患者的血液动力学变化与镇静前比较均无统计学意义(P>0.05),老年患者的靶控浓度、累积量和需要的时间均显著低于非老年组(P<0.001)。结论:丙泊酚靶控输注镇静应用于硬膜外麻醉下的老年患者时应注意靶控浓度、丙泊酚的累积量和时间,只要将OAA/S评分控制在3分,就能较好的应用于老年患者。

Objective： To assess the effect of target-controlled infusion with propofol for sedation in elderly patients undergoing epidural anesthesia. Methods： ASA Ⅰ - Ⅱ patients, undergoing elective surgery under epidural anesthesia were studied. They were assigned to two groups according to age： the elderly group （65 to 80 years）, the non-elderly group （18 to 55 years）. Both were 20 patients. After anesthesia effect was confirmed and hymodynamics was stable, TCI with propofol was given. Target sedation level was OAA/S grade 3. The hymodynamics after sedation and the time reaching OAA/S grade 3 target were recorded. The concentration of propofol, accumulated dose of propofol and time to target sedation level were observed. Results： There was no significant correlation in hymodynamics between two groups. The target concentration of propofol and accumulated dose in elderly group were lower than those in non-elderly group （ P 〈0.001 ）. Time to target sedation level in elderly group was shorter than that in adult group. Conclusions：Target concentration of propofol, accumulated dose of propofol and time to target sedation level should be paid attention to when targetcontrolled infusion with propofol is used for sedation in elderly patients undergoing epidural anesthesia.