不同剂量舒芬太尼复合依托咪酯对老年高血压患者气管插管反应的影响

Effects of different doses of sufentanil combined with etomidate on hemodynamic changes in the elderly patients with hypertension

目的探讨复合依托咪酯麻醉诱导时舒芬太尼的最适剂量。方法选择择期手术ASAⅠ～Ⅱ级老年高血压患者60例,年龄60～80岁,按不同剂量舒芬太尼随机分为3组,Ⅰ组:0.3μg/kg,Ⅱ组:0.4μg/kg,Ⅲ组:0.5μg/kg,分别复合相同剂量的依托咪酯,每组20例,分别测麻醉诱导前(t0)、诱导给药后(t1)、插管时(t2)及插管后1 min(t3)、3 min(t4)、5 min(t5)的直接动脉压、心率等血流动力学参数以及BIS和TOF值。结果①与诱导前相比,给药后三组BP、MAP、HR、BIS均降低(P<0.05),Ⅲ组下降较明显(P<0.05);插管时三组BP、HR、BIS均上升,Ⅰ组升高较明显(P<0.05),Ⅱ、Ⅲ组升高差异无统计学意义(P>0.05),BIS组间比较差异有统计学意义(P<0.05),但三组插管后BIS均<65。结论在术前血压控制在160/100 mmHg以下的患者中,0.4μg/kg的舒芬太尼在插管前5.5 min给药,能有效抑制插管反应,并产生最小的呼吸和循环抑制。

Objective To investigate the rational dose of sufentanil combined with etomidate during anesthesia induction. Methods 60 patients of ASA I Ⅱaged 60 80 yearold undergoing selective surgery were randomly di vided into 3 groups ,20 cases in each group, group I , group Ⅱand group Ⅲ was given sufentanil 0. 3,0. 4 and 0. 5 p,g/ kg respectively with the same dose etomidate. BP,MAP, HR, BIS and TOF were recorded before anesthesia （to ）, after administraton（h ） ,and at 0 min（t2） ,1 min（t3） ,3 min（t4） ,5 min（ts）after intubaton. Results Compared with the normal condition,the BP,MAP,HR and BIS of the 3 groups all decreased after induction（P 〈0. 05） ,it was more obvi ous in group Ill （ P 〈 0. 05 ） ; BP, HR and BIS in 3 groups all increased at t2 , and it was more obvious in group I （ P 〈 0. 05 ） ; there was no significant difference between groupⅡ and group Ⅲ（ P 〉 0. 05 ） ; there was significant difference in BIS value among the 3 groups （ P 〈 0. 05 ） ,but BIS value of 3 groups were all less than 65. Conclusion Among the elderly hypertensive patients,whose blood pressure controlled well（ BP 〈 160/100 mrnHg） , sufentanil 0. 4 p,g/kg ad ministrated at 5.5 min before intubation can inhibit the response of tracheal intubation, and acquire the minimal respira tory and circulatory depression.