依托咪酯复合丙泊酚对老年患者全麻诱导气管插管期间血流动力学的影响

HEMODYNAMIC CHANGES DURING ANESTHESIA INDUCEMENT AND INTUBATON OF ETOMIDATE COMBINED WITH PROPOFOL IN ELDERLY PATIENTS

目的：观察脑电双频指数（ bispectral index，BIS）监测下依托咪酯复合丙泊酚用于老年患者气管插管全麻诱导时的血流动力学变化。方法100例老年患者根据全麻诱导药物不同分为2组，丙泊酚（ P）组、依托咪酯（ E）组、以及联合用药1、2、3（ PE1、PE2、PE3）组，观察诱导前（ T0），置喉镜前（ T1），插管即刻（ T2），插管后1、3、5、10min（T3-T6）的收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、平均动脉压（mean arterial pressure，MAP）、心率（ heart rate，HR）及BIS值；并记录全麻诱导期间不良反应的发生率。结果与T0时比较，2组在T1时SBP、DBP、MAP、HR 均明显下降（ P ＜0.05）；T2时 P 组、PE2组 SBP、DBP、MAP 明显下降（ P ＜0.05），PE1组DBP、MAP、HR差异均无统计学意义（ P＞0.05）；T3时P组、E组、PE1组SBP、DBP、MAP差异均无统计学意义（ P＞0.05），E组与PE3组的HR显著上升（ P＜0.05）。E组在T1-T3时的SBP、DBP、MAP以及T3时HR明显高于P组（P＜0.05）；PE1组在T1-T4时的SBP、DBP、MAP明显高于P组（P＜0.05），T3时HR低于E组（P＜0.05）；PE2组在各时间点SBP、DBP、MAP、HR与P组比较差异均无统计学意义（ P＞0.05）；PE3组在T1-T6时SBP、DBP、MAP、HR均明显高于P组（P＜0.05）。2组BIS较诱导前有明显下降，组间比较差异均无统计学意义（P＞0.05）。结论与单独用药比，依托咪酯0.15mg/kg联合丙泊酚0.8mg/kg可更好维持气管插管全麻诱导期间的血流动力学稳定。

Objective To observe the hemodynamic changes of anesthesia inducement of etomidate combined with propofol in elderly patients during general anesthesia. Methods Total 100 elderly patients with general anesthesia were randomly divided into five groups of propofol（ group P ）, etomidate（ group E ）,propofol combined with etomidate 1（ group PE1 ）,2（ group PE2 ）and 3（ group PE3 ）according inducement agents. The systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）, mean arterial pressure（ MAP）,heart rate（ HR）and bispectral index（ BIS）value were recorded before inducement of anesthesia（ T0 ）,before laryngoscope insertion（ T1 ）,instant（ T2 ）,1min（ T3 ）,3min （T4）,5min（T5）and 10（T6）min after intubation in each groups. Results Compared with T0,SBP, DBP,MAP and HR at T1 were significantly reduced in five groups（P〈0. 05）;SBP,DBP and MAP were significantly reduced in group P and PE2（P〈0. 05）,and DBP,MAP,HR in group PE1 were not different from that of at T2（P〉0. 05）;SBP,DBP and MAP in group P,E and PE1 were not different from that of at T3（P〉0. 05）,HR in group E and group PE3 were significantly elevated（P 〈0. 05）. SBP,DBP and MAP at T1 -T3 and HR at T3 in group E were significantly higher than that in group P（ P 〈0. 05 ）;SBP,DBP and MAP in group PE1 at T1 -T4 were higher than that in group P（P〈0. 05）,and HR at T3 in group PE1 was lower than that in group E（P〈0. 05）;At all the time point,SBP,DBP,MAP and HR in group PE2 were not different from those in group P（P〉0. 05）;SBP,DBP,MAP and HR in group PE3 at T1 -T6 were higher than those in group P（P〈0. 05）. BIS values in five groups decreased significantly after inducement（ P 〈0. 05 ）,and there were no significant changes between groups（ P 〉0. 05 ）. Conclusion Administration of propofol 0 . 8 mg/kg combined with etomidate 0 . 15 mg/kg can achieve more stable hemodynamic changes than administration of the two agents individually.