不同方法预处理对普外科老年全麻手术病人插管期应激反应的影响

Effect of different precongitioning methods on the stress response of elderly patients during induction of general anesthesia in department of general surgery

目的 观察不同预处理方法对普外科老年病人全麻插管期应激反应的影响。方法 120例普外科择期手术需行气管内麻醉的老年病人（ASAⅠ~Ⅱ级）随机分3组,每组40例。未行麻黄素预处理的为A组,行麻黄素预处理的为B组,应用麻黄素加利多卡因预处理的为C组,观察3组诱导前（T1）、插管时（T2）、插管后2min（T3）、插管后5min（T4）等4个时间点平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO_2）、心电图（ECG）等参数的变化,记录3组阿托品与再次应用麻黄素的用量。结果 3组ECG、SpO_2无明显改变。C组在BP、HR从T2到T3的变化要比A组和B组平稳,T2时A组血压变化与C组比较差异有显著性（P〈0.01）,T3时,A组和B、C组病人HR变化差异有显著性（P〈0.05）,而MAP变化差异也有显著性（P〈0.05）。插管后5min（T4）,两组病人MAP、HR变化差异无显著性（P〉0.05）,C组麻黄素与阿托品的用量少于A组和B组（P〈0.05）,差异有显著性,A组中有12例患者收缩压（SAP）〈70mm Hg,而C组没有。结论 麻黄素加利多卡因预处理后,能有效防止普外科老年患者全麻诱导时的低血压和心率骤减,在一定程度上消除诱导插管时的应激反应,维持血流动力学的稳定。

Objective To observe the effect of different precongitioning methods on the stress response of elderly patients during induction of general anesthesia in department of general surgery. Methods 120 eases of elderly patients （ASA I-II） need to be scheduled for elective surgery by endotracheal anesthesia were randomly divided into three groups, 40 cases in each group. No ephedrine pretreatment was A group, ephedrine pretreatment for group B, the application of ephedrine and lidocaine pretreatment for group C. The changes of mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpO2）, electrocardiogram （ECG） were observed in three groups before induction （T1）, intubation（T2）, 2 min after intubation （T3）, 5 min after intubation （T4）. The atropine dosage and the dosage of ephedrine used again in three groups were recorded. Results No significant changes in SpO2 and ECG in the three groups; The changes of BP and HR from T2 to in C group were more stable than those in A group and B group. The changes of blood pressure at T2 in A group were significantly different from that of C group （P〈0.01）. At T3, there was significant difference in HR among A group,B group and C group, while the difference of MAP was also significant （P〈0.05）. 5 minutes after intubation （T4）,there was no significant difference in MAP and HR between the two groups （P〉0.05）. The ephedrine and atropine dosage in C group were less than those in A group and B group （P〈0.05）. In A group, there were 12 patients with systolic blood pressure （SAP） 〈70mmHg, while there was not in C group. Conclusion Ephedrine and liduokaline for the induction of anesthesia in Department of general surgery elderly patients can significantly prevent of hypotension and heart rate. It had the advantage to eliminate the stress response induced by intubation, maintain the stability of hemodynamics.