七氟醚用于老年患者麻醉诱导的临床观察

Clinical observation of sevoflurane for anesthetic induction in elderly patients

目的采用七氟醚吸入麻醉诱导，观察起效时间、心血管系统反应，探讨其在老年患者中应用的有效性和安全性。方法选择60例美国麻醉学会（ASA）Ⅰ～Ⅲ级择期手术，年龄65～78岁的患者，分为七氟醚吸入诱导（七氟醚组）和丙泊酚诱导（对照组）麻醉。七氟醚组药物浓度采用阶梯式下降法，即由7％每隔30S下调1％，至4％时停止下调并维持其浓度。对照组静脉滴注给予丙泊酚1．5～2．5mg／kg。在脑电双频指数（BIS）≤60时静脉注射舒芬太尼和罗库溴铵，行气管插管。记录两组睫毛反射消失（LOER）、BIS≤60时间，两组基础值、插管前及插管后1、3、5min的平均动脉压、心率、氧饱和度（SpO2）和BIS，观察插管中有无呛咳、喉痉挛等不良反应，术后随访患者对插管操作有无知晓及满意度。结果七氟醚组LOER、BIS≤60所用时间长于对照组（P〈0．01）。对照组术后血压、心率插管前低于基础值，插管后1min高于插管前，差异有统计学意义（P〈0．05）。七氟醚组平均动脉压、心率、插管后1min与插管前比较，差异无统计学意义。插管前平均动脉压与对照组比较，差异有统计学意义（P〈0．05）。插管呛咳七氟醚组和对照组分别为5例和3例，均无喉痉挛发生。随访两组患者麻醉诱导时无知晓，均满意。结论七氟醚可用于老年患者的麻醉诱导，心血管系统未见异常，不增加诱导时的不良反应，是老年患者麻醉诱导的理想选择之一。

Objective To observe the onset time, cardiovascular system reactions and side effects of anesthetic introduction with sevoflurane and to explore its reliability and safety in elderly patients. Methods Sixty American Society Anesthesiologists （ASA） Ⅰ -Ⅲ patients aged 65 -78 years who were scheduled for selective operation were selected in the study. They were randomly divided into sevoflurane inhalation induction group （sevoflurane group） and propofol induction group （control group）. In sevoflurane group, the concentration of inhaled sevoflurane was regulated according to downgrading method during the induction, and it was decreased by 1% every 30 seconds from the initial concentration of 7 % to the maintained concentration of 4%. In control group, propofol was titrated by 1.5-2.5 mg/kg. When bispectral index （BIS） was ≤60, sufentanil was administered intravenously and the patients were paralyzed with rocuronium and intubated. The extinction time of lash reflex and the achievement time of BIS≤60 in two groups were recorded. The mean arterial blood pressure （AMBP）, heart rate （HR）, oxygen saturation （SpO2） and BIS of the basic values before intubation, and lmin, 3 min, 5 min after intubation were also recorded, respectively. The side effects during intubation such as laryngeal spasm, body movements, irritating cough, restless movement during intubation were noted. The consciousness during intubation and satisfaction with induction were followed in patients after operation. Results The extinction time of lash reflex and the achievement time of BIS≤60 were significantly longer in sevoflurane group than those in control group （both P〈0. 01）. In sevoflurane group, there were no differences in MBP and HR between 1 min post intubation and preintubation. Whereas, in control group, AMBP and HR were lower before intubation than basic values, and were higher 1 min post-intubation than pre-intubation（P〈0.05）. There were irritating cough cases both in sevoflurane group and in control group （5 vs. 3）, and there was no laryngeal spasm case. All patients were satisfied with the anesthesia and had no consciousness during intubation. Conclusions Sevoflurane is a safe and effective induction agent and has little side effects. It is an ideal choice for elderly patients.