依托咪酯复合不同剂量舒芬太尼对老年喉罩置入患者心血管反应的影响

Effects of different doses of sufentanil combined with etomidate on hemodynamic changes in elderly patients with laryngeal mask airway

目的探讨老年患者复合依托咪酯诱导喉罩通气时舒芬太尼的合适剂量。方法选择择期手术，ASA分级I、Ⅱ级的老年患者60例，年龄65—80岁，采用随机数字表法分为3组，I组诱导时给予舒芬太尼0．3μg／ks，Ⅱ组诱导时给予舒芬太尼0．4μ／ks，Ⅲ组诱导时给予舒芬太尼0．5μg／ks，3组分别复合相同剂量的依托咪酯，每组20例；记录麻醉诱导前（To）、舒芬太尼给药后3min（T1）、喉罩置入即刻（T2）及喉罩置入后1min（T3）、3min（T4）、5min（T5）的SBP、DBP、MAP、HR、心排血量（cardiacoutput，CO）、每搏量变异率（stroke volume variation，SVV），并记录使用血管活性药物的次数。结果与诱导前比较，给药后3组BP均降低，差异有统计学意义（P〈0．05），且Ⅲ组较I组下降明显，差异有统计学意义（P〈0．05）；HI组HR在T4、T5较T0降低，差异有统计学意义（P〈0．05）；Ⅰ、Ⅱ组诱导后CO与T0之间比较，差异无统计学意义（P〉0．05），Ⅲ组诱导后CO明显降低，在T3、T4时为3．5L／min，明显低于I组在T3、T4时刻的3．7、3．8L／min，差异有统计学意义（P〈0．05）。Ⅲ组使用6次血管活性药物，明显多于I组的1次和Ⅱ组的2次，差异有统计学意义（P〈0．05）。结论对于老年需置入喉罩的患者，0．3、0．4μg／kg的舒芬太尼复合依托咪酯可以有效抑制置入喉罩时的心血管反应，同时不会引起BP及CO的明显降低，有助于维持老年患者的血流动力学平稳。

Objective To investigate the rational dose of sufentanil combined with etomidate during induction of anesthesia in elderly patients with laryngeal mask. Methods Sixty patients of ASA I , II aged 65-80 years old and undergoing selective surgery were randomly divided into 3 groups （n=20）： group I , group II and group II1. Group I, group II and group HI were given sufentanil 0.3, 0.4μg/kg and 0.5μg/kg respectively with the same dose of etomidate. SBP, DBP, MAP, HR, cardiac output （CO） and stroke volume variation （SVV） were recorded before anesthesia （To）, 3 min after injection of sufentanil（T1）, and at 0 min（T2）, 1 min（T3）, 3 min（T4）, 5 min（T5） after laryngeal mask airway insertion. The times of vasoactive drugs＇ use were also recorded. Results Compared with To, the SBP, DBP, MAP of the 3 groups all decreased after induction （P〈0.05）, it was more obvious in group III than group I （P〈 0.05）. The HR of group Ⅲ slowed at T4 and T5 than T1（P〈0.05）. The CO of group I and Ⅱ after induction was no statistical difference compared with To （P〉3. 05）. CO in group IU decreased at T3 and T4. The CO of group Ⅲ at T3 and T4 was 3.5 L/min. And CO of group I at the same time was 3.7 L/min and 3.8 L/min. There was no significant difference between group I and group Ⅱ（P〉0. 05）. The times of vasoactive drugs＇ use were 1, 2 and 6 respectively. There was a significant difference in the times of vasoactive drugs＇ use among the 3 groups （P〈0.05）. Conclusions Among the elderly patients with laryngeal mask airway, 0.3μg/kg or 0.4 μg/kg sufentanil administrated during induction can inhibit the response of laryngeal mask airway insertion; with minimal respiratory and circulatory depression.