老年危重患者麻醉诱导方法选择

The selection for methods of anesthesia induction in geriatric patients

目的 探讨减少老年危重患者麻醉诱导时循环波动的最佳用药方法。方法 75例 6 5岁以上ASAⅢ～Ⅳ级择期肿瘤切除患者随机分为三组 :异丙酚组 (P组 )、咪唑安定组 (M组 )和异丙酚复合咪唑安定组 (P +M组 ) ,每组 2 5例。比较三组麻醉前 ,诱导插管时 ,插管后 1、3、5、10、15、2 0min时的血流动力学变化情况。结果 麻醉诱导时血压、心率不平稳发生率P组为 4 4 % (11例 ) ,M组为 2 4 % (6例 ) ,P +M组为 12 % (3例 )。结论 复合麻醉诱导时血流动力学改变最小 ,提示对老年危重患者采取复合麻醉诱导可利用药物之间的协同作用 ,减少用药量 ,降低不良反应的程度 ,较单一用药更平稳、安全。

Objective To investigate the changes in hemodynamics of geriatric critical patients with various methods of anesthesia induction.Methods The changes in hemodynamics were observed in 75 renile critical patients (above 65 years old) with ASAⅢ to Ⅳundergoing elective tumor surgery.Results Fory four percent of patients arterial pressure and heart rate reduced after inducing ( P <0.05) in propofol group;twenty four percent of patients blood pressure and heart rate raised obviously after intubating in midazolam group,but the stimuli of intubating could not be inhibited by midazolam;hemodynamics were stable in midazolam propofol group.Conclusions The co induction combined midazolam with propofol for geriatric critical patients is safer than the induction with propofol or midazolam alone.