咪达唑仑和丙泊酚全身麻醉药物诱导对高龄患者心功能的影响

Influence of induction of general anesthesia with Midazolam or Propofol on heart function in elderly patients

目的探讨咪达唑仑与丙泊酚全身麻醉药物诱导对高龄患者心功能的影响。方法将2009年8月—2012年10月期间在我院接受非心脏手术的156例高龄患者采用数字表法随机分为观察组(78例)与对照组(78例),前者接受咪达唑仑全身麻醉,后者接受丙泊酚全身麻醉。分别在麻醉诱导前(T0)、麻醉诱导插管前1 min(T1)、麻醉诱导插管后2 min(T2)、麻醉诱导插管后5 min(T3)、麻醉诱导插管后10 min(T4)等5个时间点监测患者的心率(HR)、每搏输出量(SV)、每分输出量(CO)、平均动脉压(MAP)、外周血管阻力(SVR)、峰值速度(VpK)、净射血时间百分比(ET%)等指标。结果两组患者T0时HR、SV、CO、MAP、SVR、VpK、ET%相比差异无统计学意义(P>0.05)。与对应的T0相比,两组患者在T1～T4时的HR、SV、CO、MAP、SVR、VpK均显著下降(P<0.05),ET%则显著升高(P<0.05)。观察组患者在T1～T4时的HR、SV、CO、MAP、SVR、VpK均显著高于对照组,ET%则显著低于对照组(P<0.05)。结论与丙泊酚相比,咪达唑仑更适用于高龄患者手术过程中的全身麻醉药物诱导。

Objective To explore the influence of induction of general anesthesia with Midazolam or Propofol on heart function in elderly patients. Methods A total of 156 elderly patients who received non-cardiac operation in our hospital from August 2009 to October 2012 were randomly divided into trial group （n = 78） and control group （n = 78）. The former was given Midazolam for general anesthesia, while the latter was given Propofol. Such indexes, as heart rate （HR） , stroke volume （SV） , cardiac output （CO）, mean arterial pressure （MAP）, peripheral vascular resistance （SVR）, peak velocity （VpK） and percentage of net ejection time （ ET% ） were monitored at the time points of before anesthetic induction （ TO ） , l-rain before intubation （ T1 ） , 2-min after intubation （T2 ） , 5-min after intubation （T3 ） and 10-min after intubation （ T4 ）. Results At To, there were no significantly differences in HR, SV, CO, MAP, SVR, VpK and ET% between the two groups （ P 〉 0.05 ）. Compare with that at To, the indexes including HR, SV, CO, MAP, SVR and VpK of the two groups at Tl - T4 decreased significantly （ P 〈 0.05 ） , while ET% increased significantly（ P 〈0.05 ）. At the time points of T1 - T4, the indexes （ HR, SV, CO, MAP, SVR and VpK） were signifi- cantly higher and ET% was significantly lower in the trial group than in the control group （ P 〈 0.05 ）. Conclusion Compared with Propofol, Midazolam is more suitable for the induction of general anesthesia in elderly patients.