麻黄碱预注在老年患者无痛胃镜中的应用

Application of ephedrine pretreatment in analgesia gastroscopy of elder patients

目的观察麻醉诱导后预注麻黄碱在老年患者无痛胃镜检查中的应用效果。方法将150例老年患者(年龄≥60岁),ASA分级Ⅰ～Ⅱ级,随机均分为A、B、C三组。三组诱导前静脉注射利多卡因0.08 mg/kg,以丙泊酚2 mg/kg和麻黄碱80μg/kg混合液行麻醉诱导。A组患者在麻醉诱导前1 min先静脉注射芬太尼1μg/kg,C组在诱导后2 min单次预注麻黄碱70μg/kg,患者入睡、睫毛反射消失后开始胃镜检查。观察三组患者麻醉诱导前(T1)、麻醉诱导后2 min(T2)、麻醉诱导后5 min(T3)、麻醉诱导后10 min(T4)的收缩压(SBP)、舒张压(DBP),心率(HR),血氧饱和度(SpO2),各组患者麻醉效果、苏醒质量和苏醒时间及呛咳、呕吐、呼吸抑制、低血压、心动过缓等不良反应。结果 A、B两组T2、T3时刻SBP、DBP和HR较基础值(T1)显著降低,差异有统计学意义(P<0.05),而C组SBP、DBP和HR在各时间点比较差异无统计学意义(P>0.05),组间比较T4时刻差异无统计学意义(P>0.05)。C组低血压、心动过缓和呼吸抑制发生率分别为2%、2%、0,明显低于A组的26%、8%及8%,B组的20%、6%、2%。与A、B两组比较,C组苏醒时间平均缩短1.6 min,苏醒质量优于A、B两组。各组麻醉效果比较差异无统计学意义(P>0.05)。结论老年患者无痛胃镜检查中应用丙泊酚与麻黄碱混合液诱导后预注麻黄碱可显著减轻对循环及呼吸系统的抑制程度,血流动力学稳定,同时能缩短苏醒时间,提高苏醒质量,减少不良反应的发生率,麻醉安全性高。

Objective To observe the effect of ephedrine pretreatment after the induction of anaesthesia in analgesia gastroscopy of elder patients.Methods One hundred and fifty elder patients（age≥60years） with ASA Ⅰor Ⅱ grade,scheduled for analgesia gastroscopy with sedation were randomly devided into 3 groups.The patients in the three groups were injected with lidocaine 0.08 mg/kg before the induction of anaesthesia,and 1 minute later,injected with propofol 2 mg/kg plus ephedrine 80 μg/kg.The patients were injected with fentanyl 1 μg/kg in group A;the patients in group C were injected with ephedrine 70 μg/kg 2 minutes after the induction.When the patients were asleep and eyelash glint disappeared,gastroscopy was done.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）and SpO2 were observed at the time points of before the induction of anaesthesia（T1）,2 minutes after induction（T2）,5 minutes after induction（T3）,10 minutes after induction（T4）.The anaesthesia effect,waking quality,waking time,the number of cough,vomitting,respiratory depression bradycardia nad hypotension were recorded.Results There was no significant difference among three groups in anaesthesia effect（P0.05）.SBP,DBP,HR at T2 and T3 were lower than those at T1 in group A ang group B（P0.05）.SBP,DBP and HR at each time point were no significant different in group C（P0.05）.The incidences of hypotension,eradycardia and respiratiory depression were 2%,2%,0,they were significantly lower than those of group A（26%,8%,8%）and group B（20%,6%,2%）.Compared with group A and group B,the less recovery time was 1.6 minutes shorter,and the waking quality was better.Conclusion Ephedrine pretreatment after the induction can maintain blood circulation stable and no apnea in anaesthesia,reduce the adverse events and shorten the recovery time,improve the waking quality,so it can enhance anaesthesia quality and safety.