硫酸镁对老年高血压患者麻醉诱导期间血流动力学的影响

Influence of magnesium sulfate on hemodynamics during anesthesia induction in elderiy patients with hypertension

目的探讨不同剂量硫酸镁对老年高血压患者麻醉诱导期间血流动力学的影响。方法选择ASAII^III级老年高血压患者行择期腹部手术60例,按随机数字表法分为M1组(复合硫酸镁10mg/kg)、M2组(复合硫酸镁20mg/kg)和D组(对照组),每组20例。常规麻醉诱导后,M1组和M2组患者在插管前2min分别静脉推注硫酸镁10mg/kg和20mg/kg。记录麻醉诱导前(基础值)、插管前、插管后1、3、5min时点的心率(HR)和收缩压(SBP)、舒张压(DBP)的变化,以及心血管不良反应时间和需要药物干预情况。结果 3组患者SBP、DBP、HR不同时点比较差异均有统计学意义(P<0.05或0.01)。D组插管后HR增快大于M1、M2组相同时点(P<0.05);插管前低血压及药物干预M2组多于M1和D组(P<0.05或0.01),插管后的高血压及药物干预D组多于M1和M2组(P<0.05或P<0.01)。结论麻醉诱导期复合应用硫酸镁(10mg/kg),不增加气管插管前低血压的发生,同时有效抑制气管插管引起的心血管反应。

Objective To investigate the effects of different dose of magnesium sulfate on hemodynamics during anesthesia induction in elderly patients with hypertension. Methods Sixty elderly patients with ASA grade Ⅱ-Ⅲ scheduled for abdominal surgery were enrolled and randomly allocated into group MI（ prophylactic use of magnesium sulfate 10mg/kg）, group M2 （prophylactic use of magnesium sulfate 20 mg/kg） and group D （control group） with 20 cases in each group. Magnesium sulfate was administered in group M1 and group M2 two min before endotracheal intubation. Blood pressure and heart rate were recorded before anesthesia-induction, before intubation, lmin, 3min and 5min after endotracheal intubation. Results There were significant differences in SBP and DBP among three groups at different time points（P〈0.05 or 0.01）. The heart rate in group D was higher than that in groups M1 and M2 at corresponding time points （P〈0.05）. Compared to group Mland group D, more patients developed hypotension before intubation in group M2（P〈0.05 or 0.01）. However, more patients developed hypertension after endotracheal intubation in group D. Conclusion Incorporating magnesium sulfate （10mg/kg） into anesthesia induction may not increase the rate of hypotension before endotracheal intubation, and it may effectively mitigate the endotracheal intuba- tion-induced cardiovascular responses.