不同靶控浓度的舒芬太尼在老年患者麻醉诱导期的应用

Application of Different Target-controlled Concentrations of Sufentanil in Induction of Anesthesia of Senile Patients

目的比较不同靶控浓度舒芬太尼在老年患者麻醉诱导期对血流动力学和脑电双频谱指数（B IS）值的影响,寻求老年患者麻醉诱导期安全适宜的血浆靶控浓度。方法全麻下年龄65-80岁老年择期手术患者60例,按舒芬太尼血浆靶浓度随机分为三组：S1组,舒芬太尼血浆靶浓度为0.2ng/m l S2组,舒芬太尼血浆靶浓度为0.3ng/m l S3组,舒芬太尼血浆靶浓度为0.4ng/m l。先泵入舒芬太尼,待舒芬太尼血浆靶浓度达到预设靶浓度后泵入异丙酚（3μg/m l）,患者意识消失后静脉注射顺式阿曲库铵0.1mg/kg,待肌松满意时插管控制呼吸 记录基础值（T0）、插管前即刻（T1）、插管后即刻（T2）、气管插管后1m in（T3）、气管插管后2m in（T4）时平均动脉压（MAP）、心率（HR）及脑电双频谱指数（B IS）值、气管插管及不良反应发生率。结果血流动力学的影响：与T0比较,三组在T1时刻MAP、HR均下降（P〈0.05） 与T1比较,S2组T2、T3、T4时刻MAP、HR变化差异无统计学意义（P〉0.05）,S1组在T2、T3、T4时刻明显升高（P〈0.05）,S3组在T3、T4时刻明显降低（P〈0.05）。B IS值比较：与T0比较,三组在各时间点B IS值均降低（P〈0.05）,其中S2组在T1、T2、T3、T4时刻变化范围在45-55之间,S1、S3组在T1、T2、T3、T4时刻变化范围高于或低于45-55,显示麻醉过浅或过深。插管反应与不良反应比较：与S2比较,S1组出现插管反应较多（P〈0.05）,S3组出现不良反应较多＊P〈0.05,差异有统计学意义。结论舒芬太尼靶控输注用于老年患者全麻诱导期当异丙酚浓度为3.0μg/m l（TC I）时较为安全适宜的血浆靶浓度为0.3ng/m l。

Objective To compare the different target - controlled concentrations of sufentanil induction of anesthesia in elderly patients on hemodynamics and bispectral index （BIS） values, to seek safety in elderly patients during induction of appropriate target - controlled concentrations of plasma. Methods Under general anesthesia aged 65 - 80 years old 60 patients undergoing elective surgery, according to the target plasma concentrations of sufentanil,were randomly divided into three groups： S1 group, sufentanil plasma target concentration of 0.2ng/ml; S2 group, sufentanil plasma target concentration of 0. 3ng/ml; S3 group, sufentanil plasma target concentration of 0. 4ng/ml. The first pump sufentanil until the target plasma concentration of sufentanil target concentration, pre - pumped into the effects of propofol （3 μg/ml）, when patient＇ s consciousness disappeared after the intravenous injection of cis - atracurium 0. 1 mg/kg, intubation to be satisfied with control of muscle relaxation breathing ; record baseline （ T0 ）, immediately before intubation （ T1 ）, immediately after intubation （ T2 ）, after intubation lmin （T3） , after intubation 2min （T4） when the mean arterial pressure （MAP）, heart rate （HR） and bispectral index （BIS） values, tracheal intubation and the incidence of adverse reactions.Results Hemodynamics： comparison with T0, T1 times in the three groups of MAP, HR decreased （P 〈 0. 05） ; and T1 compared, S2 group T2, T3 , T4 moment of MAP, HR change was no significant difference （P 〉 0. 05）, S1 group T2, T3, T4 time was significantly higher （P 〈0. 05）, S3 group T3, T4 always significantly lower （P 〈 0. 05）. BIS value of comparison ： compared with To, three groups of BIS values at all time points were lower （P 〈0. 05）, in which S2 group T1, T2, T3, T4 in the 45 -55 times range between, S1, S3 Group T1 , T2, T3 , T4 always be higher or lower than the 45 -55 range, indicating too shallow or too deep anesthesia. Comparison of intubation response and adverse reactions： the S2 compared, S1 intubation group appears more responsive, P 〈 0. 05, S3 group of adverse reactions are more, P 〈 0. 05, the difference was statistically significant. Conclusion Sufentanil target controlled infusion for induction of anesthesia in elderly patients when the propofot concentration of 3.0μg/ml （TCI）, when safer suitable target plasma concentration of 0. 3ng/ml.