麻黄碱预先给药对老年高血压患者丙泊酚麻醉无痛胃镜检查时血流动力学的影响

Effects of ephedrine premedication on hemodynamics in elderly patients with hypertension undergoing propofol analgesic gastroscopy

目的观察老年高血压患者进行丙泊酚麻醉无痛胃镜检查时，麻黄碱预先给药对患者血流动力学的影响及其安全性和有效性。方法选择行无痛胃镜检查的老年高血压患者60例（年龄60—75岁），ASA分级为Ⅱ～Ⅲ级，随机分成丙泊酚＋利多卡因组（对照组）和丙泊酚＋利多卡因＋麻黄碱组（麻黄碱组），每组30例。按照丙泊酚总剂量1．2mg／kg估算，静脉注射丙泊酚总剂量一半时对照组给予生理盐水1．5ml，麻黄碱组给予麻黄碱0．1mg／kg，再静脉注射丙泊酚。待患者入睡后行胃镜检查。观察2组麻醉诱导前（T1）、麻醉诱导后（置镜前）（T：）、置镜后1min（T3）、置镜后3min（T4）、退镜后1min（T5）、退镜后5min（T6）、退镜后10min（T，）的血压、心率及脉搏血氧饱和度（SpO2）的变化。记录2组患者丙泊酚用量、麻醉效果（优良率）、苏醒时间及呛咳、呼吸抑制（SpO2〈92％）、低血压、心动过缓等不良反应。结果与TI时点比较，对照组在T2～T6时点收缩压（SBP）明显下降，T2～T4时点心率减慢（P〈0．05）；麻黄碱组在L、T4时点SBP轻度下降（P〈0．05），各时点心率无明显变化（P〉0．05）。在T2～T5时点，麻黄碱组SBP明显高于对照组（P〈0．05）。2组丙泊酚用量、麻醉效果及清醒时间无明显差异（P〉0．05），呛咳、呼吸抑制不良反应发生率都比较低，差异无统计学意义（P〉0．05）。结论老年高血压患者丙泊酚麻醉无痛胃镜检查时，麻黄碱预先给药可以减轻血压下降幅度，有利于维持循环功能的稳定，安全可靠。

Objective To observe the effects of ephedrine on hemodynamics in elderly patients with hypertension undergoing propofol analgesic gastroscopy. Methods 60 elderly patients with hypertension （aged 60 -75 years） with ASA II or m, scheduled for analgesic gastroscopy were randomly assigned to propofol ＋ lidoeaine group （control group） and propofol ＋ lidoeaine ＋ ephedrine group （ ephedrine group, n = 30 each）. Based on the estimated total dose of 1.2 mg/kg propofol, when half of the total dose of propofol were injected, control group received intravenous injection of 1.5 ml normal saline and ephedrine group received intravenous injection of 0.1 mg/kg ephedrine. Then the rest dose of propofol was intravenously injected. Gastroscopy was performed after sedation. Blood pressure, heart rate （HR） , and pulse oximeter oxygen saturation （ SpO2 ） were observed at following time points ： before the induction of anesthesia （ T1 ）, after the induction of anesthesia （ before placement of gastroscope） （ T2 ）, 1 rain （ T3 ） and 3 rain （ T4 ） after placement of gastroscope, 1 rain （ T5 ） , 5 rain （ T6 ） , and 10 rain （ T7 ） after withdrawing the gastroscope. The incidence of cough, respiratory depression, hypotension, and bradycardia as well as the dose of propofol, anesthesia effect, gastroscopy time, and awakening time were recorded. Results Compared with systolic blood pressure （SBP） at T1 , the SBP dropped significantly at T2 - T6 in control group while only dropped slightly at T3 and T4 in ephedrine group （ P 〈 0. 05 ）. Compared with HR at T1 , the HR was slower at T2 -T4 in control group and no significant changes were observed at different time points in ephedrine group （P 〉 0.05 ）. There was no significant difference between the two groups in anesthesia effect, dose of propofol, and awakening time （P 〉 0.05 ）. No significant difference in the incidence of cough and respiratory de- pression was observed between the two groups （P 〉 0.05 ）. Conclusion Ephedrine premedication after the induction can maintain blood circulation stable during anesthesia, so it can enhance anesthesia quality and safety in elderly patients with hypertension undergoing propofol analgesic gastroscopy.