依托咪酯与丙泊酚全麻诱导对老年患者心血管稳定性的比较研究

Comparative Study of the Effects of Etomidate and Propofol Anesthesia Induction on Cardiovascular Stability in Elderly Patients

目的比较依托咪酯与丙泊酚在麻醉诱导时对于老年患者心血管稳定性的影响,旨在指导临床对老年患者全麻诱导的药物选用.方法 60例老年患者随机分成2组:依托咪酯针组(A),丙泊酚针组(B),诱导采用咪达唑仑0.2 mg/kg,A组采用依托咪酯针剂0.3 mg/kg,B组采用丙泊酚针剂1.5 mg/kg,选用万可松0.1mg/kg,芬太尼3μg/kg静注.分别检测诱导前,诱导后1 min、2 min和5 min的HR、SBP、DBP及MAP.观察不良反应:恶心、呕吐、静脉注射痛、不自主肌肉活动、过敏反应.结果麻醉前后比较:2组患者在麻醉诱导后HR、SBP、DBP和MAP与诱导前基础值比较均出现不同程度的下降,而在1 min和5 min时患者的MAP的下降明显(P<0.05);2组间对比:A组较B组在麻醉诱导后2 min和5 min的SBP、MAP下降明显(P<0.05);2组副反应作用比较:2组患者均无恶心、呕吐及过敏反应,B组有静脉注射痛,A组出现不自主肌肉活动,2者比较有统计学意义(P<0.05).结论依托咪酯和丙泊酚对老年患者的心血管稳定性均有不同程度的抑制,但依托咪酯较丙泊酚对患者血循环影响较小、血管稳定性较好.依托咪酯更适合作为老年患者静脉麻醉诱导首选药.

Objective To compare the effects of etomidate and propofol anesthesia induction on cardiovascular stability in elderly patients,and to guide drugs use in the anesthesia induction in elderly patients.Methods 60 elderly patients were randomly divided into two groups：acupuncture group etomidate（A）,propofol needle group（B）,induced by 0.2 mg/kg of midazolam maleate tallet.Patients in A group were given 0.3 mg/kg of etomidate,and patients in B group were given 1.5 mg/kg of propofol-pin.All patients were also intravenously injected 3 μg/kg of Norcuron and 0.1 mg/kg of Fentanyl.HR,SBP,DBP and MAP of patients were recorded before induction,1 min,2 min and 5 min after induction.The adverse reactions including nausea,vomiting,intravenous pain,involuntary muscle activity and allergic reactions were also observed.Results Compared with baseline values before induction of anesthesia,HR,SBP,DBP and MAP of patients in both groups were decreased in different degrees after induction of anesthesia.The decrease was statistically significant at 1 min and 5 min after induction of anesthesia（P0.5）.Compared with B group,The decrease of SBP and MAP was more obvious in A group at 2 mins and 5 mins after induction of anesthesia（P0.5）.There were no nausea,vomiting and allergic reactions in two groups.There was intravenous injection pain in B group and involuntary muscle activity in A group,there was a significant difference（P 0.05）.Conclusion Both etomidate and propofol inhibit the cardiovascular stability in elderly patients in different degrees,but etomidate has less effect on the circulation of patients and vascular stability,so etomidate is more suitable as the preferred intravenous anesthetic induction drug for elderly patients.