舒芬太尼用于高龄患者全麻诱导气管插管的临床研究

Effect of Sufentanil on elderly patients with general anesthesia induction of endotracheal intubation

目的观察舒芬太尼用于高龄患者全麻诱导气管插管的临床效果。方法选择ASAⅡ~Ⅲ级,需在气管插管全身麻醉下行四肢手术的高龄（年龄≥80岁）患者45例,随机分三组：舒芬太尼0.15μg/kg组（S1组）、舒芬太尼0.25μg/kg组（S2组）及芬太尼2μg/kg组（F组）,每组15例。所有患者均分别记录基础值（T0）、插管前1 min（T1）、插管后1 min（T2）和插管后5 min（T3）的收缩压（SP）、舒张压（DP）和心率（HR）,并计算各时间点SP与HR的乘积（RPP）;记录不良反应的发生及药物使用情况。结果三组T1时间点BP和T3时间点SP、S2组T2时间点SP和F组T3时间点DP均显著低于同组T0时间点（P均〈0.01）,F组T2时间点DP显著高于同组T0时间点（P〈0.05）和S2组同时间点（P〈0.05）,S1组和S2组T1时间点SP、S2组T2时间点BP均显著低于F组同时间点（P〈0.01或0.05）。S1组和F组T2时间点HR均显著大于同组T0时间点（P均〈0.01）和S2组同时间点（P〈0.05）。三组T1、T3时间点RPP均显著小于同组T0时间点（P〈0.01或0.05）。F组T2时间点RPP显著大于同组T0时间点（P〈0.05）和S2组同时间点（P〈0.05）。S2组声带活动发生率、丙泊酚和瑞芬太尼使用率小于S1组,罗库溴铵、新福林使用率均显著小于S1组和F组（P〈0.05）。结论舒芬太尼0.25μg/kg用于高龄患者全麻诱导,不仅能抑制插管反应,减少不良反应,而且能保持插管前后心血管功能稳定和心肌氧供需平稳,安全可行。

Objective To observe the clinical effect of sufentanil on elderly patients with general anesthesia induction of endotracheal intubation. Methods Fourty-five patients aged 80 or above with ASA Ⅱ- Ⅲ level who needed to be conducted tracheal intubation general anesthesia downlink limbs surgery were selected and divided into three groups,with fifteen cases in each group. Group S1 was given 0. 15 μg / kg sufentanil,group S2 was given 0. 25 μg / kg sufentanil and group F was given 2 μg / kg fentanyl. All patients were respectively recorded based value（ T0）,1 min before intubation（ T1）,1 min after intubation（ T2）and 5 min after intubation（ T3） of SP and DP and HR,and calculate the SP at each time point and the product of HR（ RPP）.The occurrence of adverse reactions and drug use were also recorded. Results BP at T1 time and SP at T3 time of the three groups,SP at T2 time of group S2 and DP at T3 time of group F were significantly lower than the that at T0 time point（ P〈0. 01）,DP at T2 time of group F was significantly higher than that at the T0 time point（ P〈0. 05） and group S2 at the same time points（ P〈0. 05）,SP of group S1 and group S2 at T1 time point,BP at T2 time point of group S2 were significantly lower than that of group F with time points（ respectively P〈0. 01,0. 05）. HR of group S1 and groups F at T2 time points were significantly greater than that at the T0 time point（ P〈0. 01） and group S2 at the same time points（ P〈0. 05）. RPP at T1,T3 points in the three groups were significantly less than that at T0 time points（ respectively P〈0. 01,0. 05）. RPP at T2 time point of group F significantly greater than that at the T0 time points（ P〈0. 05） and group S2 at the same time points（ P〈0. 05）. Incidence of vocal activity,utilization rate of propofol,remifentanil signllificantly of group S2 was less than that of S1 group,rocuronium and phenylephrine were significantly less than those of group S1 and F（ P〈0. 05）. Conclusion Sufentanil 0. 25 μg / kg for elderly patients with general anesthesia induction can not only restrain intubation response,reduce adverse reactions,and can also maintain stability before and after intubation cardiovascular function and myocardial oxygen supply and demand of steady,is safe and feasible.