靶控输注依托咪酯用于老年患者全麻诱导

Etomidate TCI mode for drug research for elderly patients during anesthesia induction

目的探讨依托咪酯靶控输注(TCI)给药用于老年患者全麻诱导的研究。方法选择ASAⅡ或Ⅲ级行手术治疗的的老年患者110例,年龄68～86岁,随机均分为依托咪酯TCI组(A组)和对照组(B组)。A组依托咪酯采用TCI,血浆靶浓度设定为2.5μg/ml;B组依托咪酯采用静脉推注,剂量先按0.3mg/kg设定。观察患者入室时(T1)、依托咪酯注射过程中入睡前且BIS<90(T2)、入睡且BIS<60(T3)、喉镜暴露插管(T4)、插管后1min(T5)、5min(T6)等的HR、SBP、DBP、BIS值。同时观察A组患者入睡时的靶浓度和B组患者入睡时依托咪酯的用量;观察两组患者诱导至意识消失的时间及诱导过程中发生肌震颤的例数。结果 T4时B组HR明显快于,SBP、DBP明显高于A组(P<0.05),T5时B组HR明显快于,SBP、DBP明显低于A组(P<0.05)。B组依托咪酯用药量明显高于A组(P<0.05)。A组诱导至意识消失的时间为(9.7±1.2)s,明显长于B组的(6.1±1.1)s(P<0.05)。A组肌震颤发生的例数0例,明显低于B组的17例(P<0.05)。结论依托咪酯诱导时采用TCI血浆靶控模式给药对于高龄患者血流动力学稳定和减少不良反应更具优势。

Objective Discuss etomidate TCI mode for drug research for elderly patients during anesthesia induction.Methods Select ASA II or III level of surgical treatment of 110 cases of senile patients, randomly divided into groups A and B （n = 55）. Anesthesia was induced with： group A of etomidate plasma using TCI mode, the target concentration was set to 2.5 μg/ml; group B etomidate use manual intravenous bolus dose of 0.3 mg/kg anesthetic. SBP, DBP,BIS were observed in patients with burglary （T1）, etomidate injection process before going to sleep and BIS 〈90 （T2）, sleep and BIS〈60 （T3）, laryngoscopy intubation （T4）, 1 min after intubation （Ts）, 5 min after intubation （T6）. Group A of patients to fall asleep while watching the target concentration and group B patients to fall asleep when the amount of etomidate; Also during induction were observed number of cases occurring muscle twitch.Results Compared with group A,HR,SBP and DBP at T4 in group B were significantly increased（P〈0.05）;HR was increased and SBP,DBP were decreased at T5 in group B（P%0.05） ;dosage of etomidate in group B was more（P〈0.05）.The time of induction to loss of consciousness in group A was （9.7±1.2）s,that was longer than group B（ 6.1±1. 1）s（P〈0.05）. Cases of amyostasia in group A was 0, that was less than 17 of group B （P 〈 0.05）. Conclusion Etomidate induction by TCI plasma target control mode of administration for elderly patients with hemodynamic stability and reduce the side effects of more advantages.