不同剂量依托咪酯用于老年患者麻醉诱导气管插管时对镇静深度的影响

Effect of different etomidate doses on hemodynamics and the depth of sedation during anesthesia induction in aged people

目的观察不同诱导剂量依托咪酯复合舒芬太尼用于老年患者麻醉诱导对镇静深度的影响。方法65岁以上老年患者60例，按照依托咪酯诱导剂量随机分为四组：A组0．2mg／kg，B组0．3mg／kg，C组0．4mg／kg，D组0．5mg／kg。观察并记录诱导前（T0）、插管前（T1）、插管即刻（T2）、插管后1min（L）、3min（T4）和5min（T5）的MAP、HR和BIS变化。结果A、D组血流动力学波动比B、C组明显。T2～T5时D组BIS明显低于其它三组（P〈0．05或P〈0．01），T4、T5时A组BIS明显高于其它三组（P〈0．01）。结论依托咪酯0．3～0．4mg／kg复合舒芬太尼0．3μg／kg较适合老年患者麻醉诱导，镇静深度适中，循环较平稳。

Objective To observe hemodynamic parameters and Bispectral index （BIS） of aged people anesthetized by different doses of etomidate during anesthesia induction and tracheal intubation and to investigate the suitable dose of etomidate for aged people with fewer hemodynamic variations during anesthesia induction and tracheal intubatio Methods Sixty aged patients（〉65 years） were involved and randomly assigned to 4 groups according to the dose of etomidate they received： group A （0.2 mg/kg）, group B（0.3 mg/kg）, group C（0. 4 mg/kg）, and group D（0.5 mg/kg）. Tracheal intubation was facilitated by 0.02 mg/kg midazolam, 0.3 μg/kg sufentanyl, different dose of etomidate and 0.1 mg/kg rocuronium sequently. Mean bood pressure （MBP）, heart rate（HR）, BIS were monitored and recorded during the procedure of anesthesia induction and tracheal intubation. The observation was ended 5 minutes after tracheal intubation. Results There was no demographic differences between groups. BIS of the four groups were comparable before anesthesia and after administered with different dose of etomidate, BIS of group A and group D were higher and lower than other groups respectively over the rest （T3-T5） of the observation（P〈0.05 or P〈0. 01）. MAP of group A and group B were higher than group C and group D after anesthesia induction（P〈0. 05 or P〈0. 01）. MAP of group A was higher than group B, C, D（P〈0.05 or P〈0.01） during and after tracheal intubation. HR of group D was lower than the other 3 groups（P〈0. 05 or P〈0.01） 1 and 3 minutes after tracheal intubatiora Conclusion Etomidate 0.2-0. 5 mg/kg can bring adequate depth of sedation in aged people. Group B（etoidate 0.3 mg/kg） and group C（etoidate 0.4 mg/kg） with 0.3 μg/kg sufentanyl showed more stable hemodynamics compared with other groups in old people who undergo anesthesia induction and tracheal intubation.