七氟醚不同诱导方式对老年患者血流动力学的影响

Effects of different sevoflurane induction on hemodynamics in elders

目的比较七氟醚逐渐增加吸入浓度诱导与高浓度快速吸入诱导两种诱导方式对老年患者血流动力学的影响。方法全麻下择期手术的65岁以上老年患者40例,随机均分为逐渐增加吸入浓度诱导组(IS组)和高浓度快速吸入诱导组(RS组)。IS组七氟醚初始吸入浓度为2%,每3次呼吸递增1%直至4%～5%;RS组吸入5%七氟醚。记录两组睫毛反射消失时间、脑电双频指数(BIS)降至60的时间及无意识肢动、呛咳、喉痉挛、屏气发生情况。分别于诱导前(T1)、吸入即刻(T2)、吸入后1min(T3)、2min(T4)、5min(T5)、插管即刻(T6)和插管后1min(T7)、5min(T8)记录HR、SBP、DBP、MAP、SpO2及BIS等指标。结果 RS组2例发生呛咳、体动,IS组1例发生呛咳。RS组睫毛反射消失时间为(64.2±33.7)s,明显快于IS组的(138.0±82.7)s(P<0.05)。RS组BIS降至60的时间为(189.1±28.7)s,明显快于IS组的(232.2±36.8)s(P<0.05)。与T1时比较,RS组从T3后BIS开始下降,而IS组则从T5后才开始下降(P<0.05)。RS组T2～T4时BIS明显低于IS组(P<0.05)。结论七氟醚吸入诱导对老年患者血流动力学无明显影响。逐渐增加吸入七氟醚浓度诱导时间略长于高浓度快速吸入诱导,吸入1min后BIS明显下降。

Objective To compare the effects of sevoflurane incremental and high concentration rapid inhalation induction on hemodynamics in elders.Methods Forty aged over 65 years patients undergoing general anesthesia were equally randomized into incremental sevoflurane induction group（IS）and high concentration rapid sevoflurane induction group（RS）.In IS group,patients were inspired sevoflurane from 2% to 5% via increasing 1% sevoflurane every 3 breaths.The initiation concentration of sevoflurane was 5% in RS group.The time of eyelash reflex loss,the time of BIS decreased to 60,and the incidence of cough/body move were also recorded.HR,SBP,DBP,MAP,SpO2,and BIS were measured before the induction（T1）,at the beginning of inspiration（T2）,1 min（T3）,2 min（T4）,5 min（T5）after inspiration,at the time of intubation（T6）,and 1 min（T7）,5 min（T8）after the intubation.Results There were 2 cases occurring cough or body move in RS group and 1 case in IS group.The time of eyelash reflex loss in RS group was significantly faster than in IS group [（64.2±33.7）s vs（138.0±82.7）s]（P〈0.05）.The time of BIS decreased to 60 in RS group was shorter than in IS group [189.1±28.7）s vs（232.2±36.8）s]（P〈0.05）.BIS decreased after 1 min sevoflurane inhalation in RS group and 5 min in IS group respectively.At the beginning of sevoflurane inspiration and after inspiration 1,2 min,BIS in RS group were significantly lower than in IS group（P〈0.05）.Conclusion Sevoflurane inhalation induction has little effect on the hemodynamics in elders.The time of high concentration rapid sevoflurane inhalation induction is shorter than incremental sevoflurane inhalation induction.BIS decreased 1 min after sevoflurane inhalation in RS group.