分次预给咪唑安定诱导能有效降低老年患者全身麻醉气管插管引起的应激反应

Effect of induction of force-injection with midazolam on stress response to tracheal intubation in elderly patients

目的:观察分次预给咪唑安定诱导对老年患者插管时血流动力学及血清皮质醇的影响。方法:65岁以上,ASAⅠ或Ⅱ级,拟在全身麻醉下行择期手术的64例患者,随机分为4组(n=16)。Ⅰ～Ⅲ组为实验组,诱导前5min分别静脉注射咪唑安定0.01mg/kg、0.02mg/kg及0.03mg/kg。Ⅳ组为对照组,静注生理盐水2ml;5min后以咪唑安定(Ⅰ组0.04mg/kg、Ⅱ组0.03mg/kg、Ⅲ组0.02mg/kg及Ⅳ组0.05mg/kg)、芬太尼2%g/kg、依托咪酯0.3mg/kg和罗库溴铵1mg/kg行麻醉诱导,直接喉镜下经口气管插管。记录入室安静状态下(T1)、给咪唑安定后5min(T2)、气管插管前即刻(T3)、气管插管后即刻(T4)及气管插管后1min(T5)、2min(T6)、3min(T7)、4min(T8)和5min(T9)的BP、HR、SpO2、RR,在T1和T9抽取动脉血,测定血清皮质醇。结果:①各实验组预注咪唑安定后的BP、HR与安静状态相比均有降低(P<0.05);②Ⅳ组气管插管后即刻的SBP、HR及相应的变化率显著高于各实验组(P<0.05),其中Ⅲ组的SBP和HR的变化率与Ⅰ组相比,下降显著(P<0.05)。③气管插管后5min,各组的SBP、MAP与安静状态下值相比较,均有明显下降(P<0.05,或P<0.01),各实验组的HR有明显下降(P<0.05,或P<0.01),而Ⅳ组的HR与安静状态下相比无统计学意义。与安静状态下相比较,插管后5minⅣ组的皮质醇显著增高(P<0.01),各实验组的皮质醇值显著降低(P<0.05,或P<0.01)。结论:与诱导前一次给予咪唑安定相比较预注咪唑安定诱导能有效降低老年患者全身麻醉气管插管引起的应激反应。

Objectlve：To observe the effect of induction of force-injection with midazolam on haemodynamics and serum cortisol response to tracheal intubation in elderly patients. Methods：Sixty-four ASA I or I/ patients aged over 65-year-old weighing 61-74 kg undergoing selective operation under general anesthesia were randomized into 4 groups （n = 16 each） according to midazolam doses-0.01 （ Ⅰ ）,0.02（ Ⅱ）,0.03（ Ⅲ ）,0（ Ⅳ） mg/kg before induction of anesthesia. 5 minutes later,anesthesia was induced with midazolam（ [ 0.04 mg/kg, Ⅱ 0.03 mg/kg, Ⅲ 0.02 mg/kg and Ⅳ0.05 mg/kg）,fentanyl 2 μg/kg,etomidate 0.3 mg/kg and rocuronium 1 mg/kg. Tracheal intubation was performed at 1.5 rain after rocuronium injection. BP （SBP and MAP）, HR, SpO2 and RR were continuously monitored and recorded in the resting state entering room （T1,baseline）,5 rain after midazolam injection （T2）,immediately before intubation（T3） ,immediately and 1,2,3,4,5 min after intubation（T4.5.6,7.8,9）. Blood samples were taken from artery at T1 and T9 for determination of plasma serum cortisol concentration. Results：SBP,MAP and HR decreased significantly at T2 as compared to the baseline values at T1 in the experimental groups. Compared with those in the experimental groups,the SBP,MAP and HR and variation of SBP and HR at T4 in group Ⅳ became higher. Compared with group Ⅲ,the variation of SBP and HR decreased significantly in group I . The serum cortisol was significantly smaller in group Ⅰ , Ⅱ and Ⅲ at T9 than at baseline. But it was contrary in group Ⅳ. Conclusion： Induction of force-injection with midazolam can decrease the stress response to tracheal intubation in elderly pa- tients effectively.