依托咪酯用于不同年龄患者麻醉诱导时对插管应激反应的影响

Effects of Etomidate on intubation stress response in patients of different ages during induction of anesthesia

目的 比较依托咪酯、异丙酚用于不同年龄患者全麻诱导气管插管时对心率变异性和血流动力学的影响。方法 120例择期手术患者按照年龄分组,20-〈45岁青年组（n=40）,45-〈65岁中年组（n=40）,≥65岁老年组（n=40）,每组又随机分为异丙酚组和依托咪酯组（P1、E1组;P2、E2组;P3、E3组）,异丙酚组以咪唑安定0.05 mg/kg、芬太尼3μg/kg、异丙酚2 mg/kg、维库溴铵0.1 mg/kg诱导,依托咪酯组以咪唑安定0.05 mg/kg、芬太尼3μg/kg、依托咪酯0.3 mg/kg、维库溴铵0.1 mg/kg诱导。记录诱导前（T0）、气管插管前（T1）、气管插管即刻（T2）、插管后1 min（T3）、3 min（T4）、5 min（T5）各组的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、低频功率（LF）、高频功率（HF）、LF/HF、心率变异性（HRV）的变化。结果 与T0比较,E1组T1、T4、T5时SBP、DBP、MAP、HR显著下降（P〈0.05）;T1-5时HF显著下降,LF/HF显著上升（P〈0.01）。E2组T1-5时SBP、MAP显著下降（P〈0.05）,组间比较E2组SBP、DBP、MAP明显高于P2组（P〈0.05）;两组LF/HF差异有统计学意义（P〈0.05）。E3组T1、T3-5时SBP、DBP显著下降（P〈0.05）,HR、MAP始终平稳,组间比较E3组SBP、MAP明显高于P3组（P〈0.05）;T1-5时HRV、LF、HF、LF/HF均平稳,组间比较LF、HF、LF/HF差异有统计学意义（P〈0.05）。结论 依托咪酯的优势“保持自主神经系统和循环系统功能的相对稳定性”在青年组没有体现,在中年组有所体现,在老年组优势明显。

Objective To compare the effects of Etomidate and Propofol on heart rate variability and hemodynamics during tracheal intubation under general anesthesia in different ages. Methods One hundred and twenty general anesthesia patients were divided into three groups according to the age： young group（20-〈45 years old）,middle-aged group（45-〈65 years old）,elderly group（≥65 years old）. Each group was randomly divided into Propofol group and Etomidate group（P1,E1group; P2,E2group; P3,E3group）. In the course of induction of general anesthesia,Midazolam 0.05 mg/kg,Fentanyl 3 μg/kg,Propofol 2 mg/kg and Vecuronium 0.1 mg/kg were given in the Propofol group,Midazolam 0.05 mg/kg,Fentanyl 3 μg/kg,Etomidate 0.3 mg/kg and Vecuronium 0.1 mg/kg were given in the Etomidate group. The changes of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）,low-frequency power（LF）,high-frequency power（HF）,LF/HF,heart rate variability（HRV） were recorded before induction（T0）,before tracheal intubation（T1）,at the instant just before intubation（T2）,at 1 min（T3）,3 min（T4）,5 min（T5） after intubation. Results Compared with T0,SBP,DBP,MAP,HR were significantly decreased at T1,T4,T5 in group E1（P 〈0.05）;the HF decreased significantly and LF/HF increased significantly at T1-5（P〈 0.01）. In group E2,the SBP and MAP dropped remarkably at T1-5（P〈 0.05）,but the SBP,DBP and MAP in group E2 were higher than those in group P2（P〈 0.05）. The significant difference of LF/HF was observed between the two groups（P〈 0.05）. The SBP and DBP were significantly decreased in group E3 at T1,T3-5（P 〈0.05）,while the HR and MAP were always stable. Between the two groups,the SBP and MAP in group E3 were significantly higher than those in group P3（P 〈0.05）. TheHRV,LF,HF,LF/HF were stable in group E3 at T1-5. The LF,HF and LF/HF were significantly different between the two groups（P 〈0.05）. Conclusion The advantage of Etomidate ＂keeping the relative stability of autonomic nervous system and circulatory system function＂ is not reflected in the young group,which is reflected in the middle-aged group and obvious in the elderly group.