丙泊酚靶控输注对老年患者全身麻醉血流动力学的影响

Effects of target-controlled infusion of propofol on hemodynamics during generalanesthesia in elderly patients

目的探讨丙泊酚不同用药方法对全身麻醉时老年患者血流动力学的影响。方法选取ASAI。II级择期行腹部手术老年患者40例，随机分为丙泊酚靶控输注（TcI）组与丙泊酚常规微泵恒速输注（P）组。麻醉过程中根据脑电双频指数（BIS）调整丙泊酚输注速度或靶浓度，分别记录麻醉诱导前（T0）、麻醉诱导后插管前（T。）、气管插管完成即刻（T2）、气管插管后5rain（＇r3）、切皮即刻（T4）、切皮后5min（＇r5）、气管拔管即刻（T6）两组患者相应的血流动力学参数，包括心率（HR）、收缩压（SBP）、舒张压（DBP）。同时记录各时刻BIS值、苏醒时间及术后不良反应发生率。结果与T0比较，TCI组在T2一T6各时点血流动力学指标波动较小（P〉0．05）；P组HR、SBP与DBP在T1时显著降低，T2与T6时显著升高（P〈0．05）。P组与TcI组比较，T2时SBP与DBP显著增高（P〈0．05）。TCI组患者术后睁眼、拔管时间及不良反应发生率均明显低于P组（P〈0．05）。结论靶控输注丙泊酚用于老年手术患者，血流动力学更加平稳，术后不良反应少。

AIM To compare the effect of different infusion mode of propofol on hemodynamics during general anesthesia in elderly patients. METHODS Forty elderly patients undergoing selective surgery were randomly divided into propofol target-controlled infusion （TCI） group （group TCI, n = 20） and manually-controlled pump group（group P, n = 20）. Propofol was administered via target-controlled infusion in group TCI and via manually-controlled infusion in group P,and the dosage of propofol was adjusted according to bispectral index（BIS） monitor. The hemodynamic parameters, such as HR, SBP and DBP, were observed at the following time points：before induction of anesthesia （T0）, after induc- tion of anesthesia and before intubation （T1）, immediately after intubation （T2）, 5 min after intubation （T3）, immediate- ly after skin incision （T4）, 5 min after skin incision （T5） and immediately after extubation （T6）. BIS values of all time points, time to recovery and postoperative adverse effects were recorded. RESULTS Hemodynamie variables and BIS during operation were more fluctuant in group P compared with those in group TCI（ P 〈 0.05） .The HR, SBP and DBP in group P were significantly decreased at Tt and significantly increased at T2 and T6 compared with To（ P 〈 0.05） .The SBP and DBP of group P was higher at T2 compared with group TCI （ P 〈 0.05）. There were significant differences in time to opening eyes and extubation between 2 groups （ P 〈 0.05）. The group TCI had less postoperativefew adverse effects （P 〈 0.05）. CONCLUSION The target-controlled infusion of propofol has advantages in haemodynamie stability and few adverse effects in elderly patients with surgery.