地佐辛对老年患者七氟醚吸入诱导MAC的影响

Effect of dezocine on minimum alveolar concentration in elderly patients receiving sevoflurane inhaled induction

目的:观察地佐辛用于老年患者七氟醚吸入诱导气管插管末最低肺泡有效浓度(MAC)的影响。方法:选择全麻手术60例,年龄>65岁,ASAⅠ~Ⅱ级,随机于诱导前静脉注射生理盐水(A组)、地佐辛0.1 mg/kg(D1组)或0.2 mg/kg(D2组),10 min后以七氟醚吸入诱导气管插管,记录注药前(T_1)、注药后10 min(T_2)、插管前(T_3)、插管后1 min(T_4)、插管后10 min(T_5)时的平均动脉压、心率、血氧饱和度、脑电双频指数;记录从注药开始到一次插管成功的时间(Ta),插管末七氟醚呼末浓度(MAC值)以及诱导相关不良反应。结果:3组血流动力学均较平稳,但D2组T_4时的平均动脉压较A组、D1组明显降低(P<0.05),T_3心率明显低于T_2(P<0.05),对心血管应激反应的抑制要强于A组和D1组。D2组T_4时的MAC值较A组明显降低(P<0.05);各组患者插管后Ta无显著性差异(P>0.05)。结论:0.2 mg/kg地佐辛可安全用于老年患者七氟醚吸入诱导插管,降低七氟醚吸入诱导插管末的MAC值,血流动力学稳定,不良反应少。

Objective： To observe the effect of dezocine on minimum alveolar concentration（ MAC） at the end of tracheal intubation in elderly patients receiving sevoflurane inhaled induction. Methods： 60 patients receiving general anesthesia surgery（ older than 65 years old,ASA Ⅰ-Ⅱ） were randomly intravenously injected saline（ group A）,0. 1 mg/kg（ group D1） or0. 2 mg/kg dezocine（ group D2） before induction. Ten minutes later,sevoflurane inhalation induction and tracheal intubation were performed. Mean arterial pressure（ MAP）,heart rate,oxygen saturation and bispectral index were recorded before injection（ T1）,10 min after injection（ T2）,before intubation（ T3）,1 min after intubation（ T4） and 10 min after intubation（ T5）. The time from the beginning of injection to one-time success of intubation（ Ta） and sevoflurane MAC at the end of intubation were also recorded as well as induction-related adverse reactions. Results： Hemodynamics were relatively stable in the three groups,but the mean arterial pressure of group D2 at T4 was lower than that of group A and group D1（ P 〈 0. 05）; the heart rate at T3 was significantly lower than that at T2 in group D2（ P 〈 0. 05）; in terms of cardiovascular stress response,group D2 demonstrated stronger inhibition than group A and group D1; The MAC of group D2 at T4 was significantly lower than that of group A（ P 〈 0. 05）,and there was no significant difference in Ta among the three groups（ P 〉 0. 05）. Conclusion： 0. 2 mg/kg dezocine can be safely used for sevoflurane inhalation induction and tracheal intubation in elderly patients. It can reduce sevoflurane MAC at the end of intubation,stabilize hemodynamics and lower adverse reactions.