不同剂量丙泊酚在全麻术中对老年患者应激反应的影响

The effects of different doses of propofol on the stress in elderly patients

目的观察不同剂量丙泊酚对老年患者应激反应的影响。方法选择择期行上腹部手术的老年患者60例,ASAⅠ-Ⅱ级。随机分为三组,每组20例,A组为术中持续泵注丙泊酚4mg/(kg.h),B组为丙泊酚6mg/(kg.h),C组为丙泊酚8mg/(kg.h)。分别记录入室后(T0)、麻醉诱导后3分钟(T1)、插管后1分钟(T2)、切皮后2分钟(T3)、关腹后(T4)及拔管后(T5)各时间点的HR、MAP及BIS,观察血浆皮质醇(CORT)浓度的变化。结果三组患者给药后心率与基础值比较均有变化(T2时刻除外),在T4时C组心率比A、B两组均快(P<0.05),在T5时刻A组比B组心率快。MAP在给药后T1、T2、T3、T4与基础值比较均降低(P<0.05),在T3、T4、T5时刻A组比C组MAP值高(P<0.05)。给药后各时间点BIS值比基础值均降低,组间比较在T3时刻A比C组BIS值高,在T4时A比B、C组BIS值高(P<0.05)。CORT在给药后T1时刻与基础值比较值降低,在T4、T5时比基础值升高,组间比较在T3、T4、T5时A与B、C均有统计学意义(P<0.05)。结论不同剂量的丙泊酚对抑制老年患者应激反应不同,当麻醉维持中以6mg/(kg.h)泵入时,各指标变化相对比较平稳。

Objective To explore the effects of different doses of propofol on the stress in elderly patients. Methods Sixty elderly patients scheduled for selective upper abdominal surgery with general anesthesia were randomly divided into three groups （n = 20）. Group A was infusion of propofol 4 mg / kg · h, group B of propofol 6 mg / kg · h, and group C of propofol 8 mg / kg · h. HR, MAP and BIS were recorded as follow ： when patients entered the operating room （ T0）, 3 min after induction of anesthesia （ T1 ）, 1 min after intubation （T2）, 2 min after skin incision （T3）, after abdominal close （T4）, and after extubation （T5）. Meanwhile, measured plasma＇s CORT concentrations. Results There were statistical significant differences in HR after administration when compared with previous administration （expect T2）. HR at T4 moment group C was faster than that in other two groups （P 〈0. 05）. And at T5, HR of group A was faster than that of group B and group C. MAP at T1, T2, T3, T4 were decreased compared with previous administration （P 〈0. 05）, and at T3, T4, T5, group A was higher than group C. After administration, BIS was lower than the previous administration （P 〈 0. 05）, At T3, the BIS of group A was higher than the group C, and at T4, the BIS was also higher in group A compared with group B and group C. CORT at T1 was lower than previous administration （P 〈0. 05）, but at T4 and T5 was higher （P 〈0. 05）. At T3, T4, the results of CORT in group A compared with B and C had significant differences （ P 〈 0. 05 ）. Conclusion Different doses of propofol have different anti - stress effects. When the dosage of propofol is to maintain the 6 mg / kg · h infusion, the index is relatively stability.