雷米芬太尼靶控输注在老年患者全麻诱导中的应用

Application of plasma target controlled infusion of remifentanil in elderly patients during induction of general anesthesia

目的比较雷米芬太尼不同血浆靶控浓度在老年患者全麻诱导中的应用。方法老年患者（≥65岁，A组）和青壮年患者（（60岁，B组）各40例，每组又随机均分为四个亚组：A1、A2、A3、A4、B1、B2、B3、B4，分别输注雷米芬太尼靶控血浆浓度为1、2、3、4ng／ml，5min后开始靶控输注丙泊酚（血浆浓度2．5μg／ml），10min后给维库溴铵0．1mg／kg，2min后行气管插管。记录各时刻患者的BP、HR、Grant气管插管评分、BIS及血管活性药物的使用及不良反应的发生情况。结果A组相对于同浓度B组阿托品和麻黄碱的使用例数增多（P＜0．05），A1、A2、A3组使用阿托品的例数少于A4组（P〈0．05），A2、A3组使用硝酸甘油的例数分别少于B2、B3组（P＜0．05），B2、B3组多于B4组（P〈0．05）。各浓度的雷米芬太尼均引起BIS的轻度下降，而雷米芬太尼输注后BP虽有轻度下降，但差异无统计学意义。插管评分，B1组明显高于其他亚组（P＜0．05）。相对于气管插管前即刻，气管插管后1min与切皮后2min各组BP均有上升，A3、A4和B4组BP上升、HR增快的幅度较小。结论靶控输注雷米芬太尼与丙泊酚用于老年患者全麻诱导，两者靶控浓度分别为2～3ng／ml和2．5μg／ml比较合理，诱导效果满意，且能维持血流动力学稳定。

Objective To study the changes of hemodynanics and reaction of intubation in elderly patients with plasma target controlled infusion （TCI） of remifentanil during induction of general anesthesia. Methods Forty elderly and forty adult patients, ASA class Ⅰ or Ⅱ , undergoing elective abdominal surgery were divided randomly into 8 groups with 10 cases each（A1, A2, A3, A4, B1, B2, B3, B4） and given remifentanil with the target concentration of 1, 2, 3, 4 ng/ml, respectively. Central vein was cathetered for remifentanil and peripheral vein for propofol with the target plasma controlled concentration of 2.5 μg/ml,TCI started after remifentanil infusion for 5 min. Vecuronium 0.1 mg/kg was injected 10 rain later,and intubation was carried out. Blood pressure（BP） , heart rate（HR）, bispectral index（BIS）, Grant＇s intubation score, side effects and adjuvant drugs were recorded at six time points of before anesthesia,at 5 min after remifentanil infusion, 10 min after propofol infusion, 2 rain after vecuronium infusion, 1 rain after finishing intubation, and 2 rain after incision. Results The elderly patients were of more significant changes of hemodynamics and required more atropine compared to controlled groups with the same remifentanil concentration, especially in B4 group. BIS values after infusion of remifentanil were of little decrease compared to the baseline. The intubation condition was unsatisfied in A1 group. Less BP and HR changes were seen in A3, A4, B4 groups after incision compared to those before anesthesia. Conclusion During total intravenous anesthesia with TCI of remifentanil and propofol in elderly patients for induction, the suitable target concentration of remifentanil and propofol could be 2-3 ng/ml and 2.5μg/ml,respectively.