TCI依托咪酯和瑞芬太尼用于老年麻醉的临床研究

Clinical Research on Target-Controlled Infusion of Etomidate and Remifentanil Anesthesia in Elderly Patients

目的观察靶控输注(TCI)依托咪酯复合瑞芬太尼对高龄老年患者血流动力学的影响,探讨老年患者TCI瑞芬太尼复合依托咪酯麻醉时满意的效应室浓度。方法全麻下择期手术的老年患者45例,随机分为初始效应室浓度不同的三组,每组15例:Ⅰ组设定依托咪酯初始效应室浓度为0.5mg/L;Ⅱ组设定依托咪酯初始效应室浓度为0.6mg/L;Ⅲ组设定依托咪酯初始效应室浓度为0.8mg/L。术中依托咪酯维持的效应室浓度为0.4mg/L。分别在麻醉诱导前(T0)、诱导后1min(T1)、气管插管后即刻(T2)、切皮时(T3)、拔除气管导管前(T4)、拔除气管导管后即刻(T5)和回病房后即刻(T6)时记录平均动脉压(MAP)、心率(HR),记录不良反应发生率、辅助药物使用次数、苏醒指标等。结果三组间各时点MAP、HR差异无统计学意义(P>0.05);与T0比较,各组T1时MAP和HR均降低;三组患者的依托咪酯总用药量、手术总耗时、平均效应室浓度(Ce)及清醒时间各组差异无统计学意义(P>0.05)。结论 TCI依托咪酯复合瑞芬太尼可维持稳定的血流动力学;依托咪酯0.6mg/L初始效应室浓度、0.4mg/L维持效应室浓度可为高龄老年患者提供满意的麻醉效果。

Objective To observe the effect of target-controlled infusion（TCI）of etomidate and remifentanil on the hemodynamics in elderly patients,and explore its target effect-site concentration.Methods Forty five elective surgery under general anesthesia aged patients were randomly divided into three groups（n=15）with a different initial effect-site concentration.The initial effect-site concentration of etomidate was set on 0.5 mg/L in groupⅠ,0.6 mg/L in group Ⅱ and 0.8 mg/L in group Ⅲ.The intraoperative effect-site concentration of etomidate was kept at 0.4 mg/L.The mean arterial pressure（MAP）,heart rate（HR）,incidence of adverse reactions,using frequency of ancillary drugs and waking up indicators were recorded before induction of anesthesia（T0）,1 min after inducement（T1）,immediately after tracheal intubation（T2）,during skin incision（T3）,before extubation（T4）,immediately after extubation（T5）and immediately after returning ward（T6）.Results The MAP and HR at each time point showed no statistical difference（P〉0.05）among the three groups;as compared to T0 and T1 in each group,MAP and HR were reduced;the difference in total dosage of etomidate,total surgery consumption,average effect-site concentration,and awake time had no statistical significance among the three groups（P〉0.05）.Conclusion TCI remifentanil and etomidate can maintain a stable hemodynamics;the initial effect-site concentration of 0.6 mg/L etomidate and maintain concentration of 0.4 mg/L etomidate can provide satisfactory anesthesia effect in elderly patients.