不同剂量舒芬太尼用于老年患者全麻诱导的临床观察

Clinical Observation of the Effects of Different Dosages of Sufentanil in Induced General Anesthesia in the Elderly

【目的】比较不同剂量舒芬太尼用于老年患者全麻诱导插管时对患者血流动力学和应激激素的影响。【方法】将60例因消化道肿瘤需在全麻下行直肠癌或结肠癌根治术的老年患者按舒芬太尼不同剂量均分为Ⅰ、Ⅱ、Ⅲ组，各组全麻诱导时使用的舒芬太尼剂量分别为0．2μg／kg、0．3μg／kg、0．4μg／kg，于麻醉诱导前（T0）、插管前（T1）、插管后即刻（T2）、插管后5min（T3）记录平均动脉压（MAP）、心率（HR）及去甲肾上腺素（NE）、肾上腺素（E）浓度。【结果】插管前（T1）时点，三组的MAP、HR较T0时点均有所下降（P〈0．05），三组间比较，Ⅲ组的MAP、HR低于Ⅰ组、Ⅱ组（P〈0．05）。插管后即刻（T2）时点，Ⅰ组的MAP、HR较T0时点有所升高且高于Ⅱ组、Ⅲ组（P〈0．05）。插管后5min（T3）时点，Ⅲ组MAP、HR较T0时点有所降低（P〈0．05）且低于I组、Ⅱ组（P〈0．05）。插管前（T1）时点，各组E血浆浓度差异无统计学意义（P〉O．05）。插管后即刻（T2）时点与插管后5min（T3）时点，Ⅰ组E血浆浓度较T0时点有所升高，且高于Ⅱ组、Ⅲ组（P〈0．05）。Ⅱ组、Ⅲ组E血浆浓度较T0时点其差异无统计学意义（P〉0．05）。【结论】对于老年患者，使用0．3μg／kg舒芬太尼行全麻诱导插管，既能有效抑制插管反应，又能较好的维持血流动力学稳定。

[Objective]To compare the effects of different doses of sufentanil on hemodynamics and stress hormones in the senile patients during general anesthesia. [Methods] Sixty senile patients with gastrointestinal cancer who needed radical surgery of rectal cancer or colonic cancer under general anesthesia were selected. According to the dosage of sufentanil, all patients were divided into Ⅰ , Ⅱ and Ⅲ groups with 0.2μg/kg, 0.3 μg/kg and 0.4μg/kg sufentanil in each group, respectively. Mean arterial pressure（MAP）, heart rate（HR）, norepinephrine（NE） and epinephrine（E） were recorded before induction of anesthesia （T0）, before intubation （T1）, immediately after intubation （T2） and 5min after intubation（T3）. [Results]Compared with T1 time point, MAP and HR of three groups decreased at T0 time point（ P 〈0.05）. Among three groups, MAP and HR of group m were lower than those of group Ⅰ and Ⅱ （ P 〈0.05）. Compared with TO time point, MAP and HR of group Ⅰ increased at T2 time point（ P 〈0.05） and were higher than those of group Ⅱ and Ⅲ （ P 〈0.05）. Compared with T0 time point, MAP and HR of group Ⅲ decreased at T3 time point（ P 〈0.05） and were lower than those of group Ⅰ and Ⅱ （ P 〈0.05）. At T1 time point, plasma concentrations of E in each group showed no significant difference（ P 〉0.05）. Compared with To time point, plasma concentration of E in group Ⅰ increased at T2 and T3 time points （ P 〈0.05） and was higher than those in group Ⅱ and m （ P 〈 0. 05）. There was no significant difference in plasma concentration of E in group Ⅱ and Ⅲ between T2 or T3 time point and TO time point（ P 〉0.05）. [Conclusion]Sufentanil 0.3μg/kg for anesthesia inductive intubation in senile patients can not only effectively inhibit intubation reaction, but also maintain more stable hemodynamics.