依托咪酯对老年患者全麻诱导期间血流动力学影响

Hemodynamic changes during general anesthesia induction by etomidate in elderly patients

目的比较依托咪酯与丙泊酚在老年患者全麻诱导过程中对血流动力学的影响,探讨血流动力学指标变化及血管活性药物的使用。方法选择30例60~70岁ASAⅠ~Ⅱ级全麻手术患者,随机分为丙泊酚组（P组）和依托咪酯组（E组）各15例。观察两组患者麻醉前（T0）、麻醉诱导后1 min（T1）、麻醉诱导后2 min（T2）,麻醉诱导后3 min（T3）,插管后3 min（T4）,各个时间点收缩压、舒张压、心率、平均动脉压、心率和二项值的变化。结果与T0时比较,E组和P组注药1、2、3 min后的SBP、DBP、MAP、RPP明显下降,有显著性差异（P〈0.01）。与T0时比较,HR在注药后1 min有显著性差异（P〈0.01）。但P组麻黄素的使用例数及用量均多于E组。依托咪酯和丙泊酚对气管插管抑制反应均无显著性差异。结论依托咪酯用于老年患者全麻诱导对血流动力学影响程度小于丙泊酚。

Objective To investigate the hemodynamic effect of propofol and etomidate during induction in elderly patients,from two aspects of hemodynamic indexes and vasoactive agents consumption. Methods Thirty ASAⅠ ~ Ⅱ patients aged 60 ~ 70 under going general anesthesia were randomly divided into group P（ propofol,n = 15） and group E（ etomidate,n =20）. The changes of SBP,DBP,MAP,HR,RPP were recorded before induction,1,2,3min after administration,and 3 min after intubation. Results The SBP,DBP,MAP,HR,RPP of group E decreased obviously after administration of 1,2,3 min. There was absolutely significant difference between pre-induction and after induction（ P〈0. 01）. After induction,the SBP,DBP,MAP,HR,RPP were significantly decreased in group P（ P〈0. 01）,and there was no significant difference of all indexes between pre-induction and 3 min after intubation（ P〉0. 05）. On the aspect of times and amount of vasoactive agent,group P exceeded group E. There was no significant difference between group E and group P on suppressing intubating reaction. Conclusion The effect of propofol on hemodynamics is obviously more potent than etomidate.