不同浓度七氟烷复合麻醉诱导在老年人中的应用效果

Application of different concentrations of sevoflurane during the induction of combined anesthesia in the elderly

目的探讨不同浓度七氟烷复合麻醉在老年患者全麻诱导中的合理应用及对麻醉深度的影响。方法择期在全麻下行腹部手术的老年患者60例，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，采用随机数字表法将患者随机分为4组（每组15例）：S1组（吸入4％的七氟烷）；S2组（吸入6％的七氟烷）；S3组（吸入8％的七氟烷）；P组（靶控血浆靶浓度3mg／L的异丙酚），待各组患者镇静警觉评分observer’s assessment of alertness／sedation，OAA／S）=1后静脉注射瑞芬太尼、罗库溴铵，2rain后行气管插管。记录各组达到意识消失、睫毛反射消失、OAA／S=1的时间及各时点的脑电双频指数（bispectral index，BIS）、听觉诱发电位指数（A-line ARX index，AAI）值；记录诱导前，注入瑞芬太尼前，插管前，插管即刻，插管后1、2、3min的平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）、BIS、AAI值。结果七氟烷组随着吸入浓度增高，S3组意识消失、睫毛反射消失、OAA／S评分：1的时间[（84±5）、（92±5）、（178±9）S]短于S1组[（109±5）、（117±4）、（197±9）s]和S2组[（95±5）、（102±5）、（188±8）要s]（P〈0．01）；S2组短于S1组（P〈0．01）。P组各时点时间[（131±4）、（139±4）、（222±8）s]较S1、S2、S3组延长（P〈0．01）。各组诱导后MAP均降至最低，组间比较P组（68．9±2．3）mmHg（1mmHg=0．133kPa）明显低于S1、S2、S3组[（76．8±6．6）、（75±3）、（75±3）mmHg]（P〈0．01）。插管后各组MAP均高于插管前，组间比较sl组[（99．3±4．6）、（95．7±4．3）mmHg]在插管后1、2min高于S2组[（96±5）、（92±4）mmHg]、s3组[（96±3）、（92±3）mmHg]、P组[（96．1±3．3）、（92．4±3．4）mmHg]（P〈0．05）。结论6％、89比氟烷复合麻醉用于老年人全麻诱导起救决、血流动力学平稳、不增加不良事件发生率，可安全可靠使用。

Objective To investigate the reasonable application of different concentrations of sevoflurane inhalation during the induction of combined anesthesia in the elderly and the effect of that on the depth of anesthesia. Methods Sixty ASA Ⅰ or Ⅱ elderly patients who undergoing elective abdominal surgery under endotracheal anesthesia were randomly divided into four groups （n=15）. In group Ⅰ , anesthesia was induced with inhalation of 4% sevoflurane （group S1 ）. In group Ⅱ , anesthesia was induced with inhalation of 6% sevoflurane （group S2）. In group m , anesthesia was induced with inhalation of 8% sevoflurane （group S3）. In group IV, anesthesia was induced with target plasma concentration of 3 mg/L propofol （group P）. Remifentanil and rocuronium were administered iv after alertness/sedation scale（OAA/S）=1 in all 4 groups, tracheal intubation was performed 2 min later. Duration from the start of induction to loss of consciousness and eyelash reflex, duration from the start of induction to OAA/S =1, electroencephalogram bispeetral index （BIS） and A-line ARX index （AAI） at corresponding points were recorded. Mean arterial pressure （MAP）, heart rate （HR）, BIS, AAI value at time of before induction, before administration of remifentanil, before intubation, tracheal intuhation, 1, 2, 3 min after intubation were recorded. Results Time to loss of consciousness, loss of eyelash reflex, OAA/S= 1 in group S3 [ （84±5）, （92±5）, （178±9） s ] were significantly shorter than that in group S1 [ （109±5）, （117±4）, （ 197±9 ） s ] and S2 [ （ 95±5 ）, （ 102±5 ）, （ 188±8 ） s ] （P〈0.01 ）, time in group S2 at corresponding points were significantly shorter than that in group S1 （P〈0.01）, time in group P[ （131±4）, （139±4）, （222±8） s ] at corresponding points were significantly longer than that in groups S1, S2 and S3（P〈0.01）. MAP in all groups reduced to the lowest value after induction, MAP in group P（68.9±2.3） mm Hg （1 mm Hg=0.133 kPa） was more lower than that in groups S1, S2 and S3 [ （76.8±6.6）, （75±3）, （75±3） mm Hg] （P〈0.01）. MAP in all groups after tracheal intubation were higher than that before tracheal intubation, and MAP in group S1 [ （99.3±4.6）, （95.7±4.3） mm Hg] were higher than that in group S2[ （96±5）, （92±4） mm Hg] ,group S3[ （96±3）,92±3） mm Hg] ,group P[ （96.1±3.3）, （92.4±3.4） mm Hg] at 1,2 min after tracheal intubation （P〈0.05）. Conclusions Induction with 6% or 8% sevoflurane combined anesthesia in the elderly can provide rapid onset time, hemodynamic stability and can be used safely without increasing the incidence of adverse events.