曲马多与依托咪酯对老年人喉罩麻醉血流动力学及镇痛效果分析

Effects of tramadol and etomidate on hemodynamics and analgesia in elderly patients with laryngeal mask airway anesthesia

目的探讨曲马多与依托咪酯在老年喉镜麻醉中的应用效果及对血流动力学和镇痛效果的影响。方法回顾性分析2015年2月至2016年10月在我院接受腹腔镜胆囊切除术的老年人的临床资料,所有患者均接受喉罩麻醉,根据其麻醉药物的不同分为对照组和观察组,对照组给予依托咪酯药物,观察组在此基础上联合应用曲马多。观察2组患者围手术期血流动力学、麻醉相关指标、视觉模拟评分(VAS)和不良反应发生率的差异。结果 2组患者麻醉前的血流动力学水平无差别,对照组患者的平均动脉压(MAP)、心率(HR)在切皮后2h、术后4h较麻醉前波动较大,2组患者的血氧饱和度(SpO2)水平无差别;2组患者的麻醉时间和手术时间无明显差别,而观察组的手术清醒时间明显较对照组短,差异具有统计学意义(P<0.05);观察组患者术后4、12和24h时的VAS得分低于对照组(P<0.05),2组的Ramsay得分无差别(P>0.05);2组患者恶心、呕吐、腹胀和认知功能障碍发生率差异无统计学意义(χ2=1.569,P=0.210)。结论曲马多与依托咪酯在老年喉镜麻醉中有较好的应用效果,对患者血流动力学影响小,术后镇痛效果好,具有良好的应用价值。

Objective To investigate the effect of tramadol and etomidate in elderly patients undergoing laryngoscopy and their effects on hemodynamics and analgesia.Methods The clinical data of elderly patients who underwent laparoscopic cholecystectomy in our hospital from February 2015 to October 2016 were retrospectively analyzed.All patients were treated with laryngeal mask airway anesthesia.According to the different anesthetic drugs,they were divided into control group and observation group.The control group was given etomidate.The differences of hemodynamics,anesthesia related indexes,VAS and adverse reactions were observed between the two groups.Results There was no difference between the two groups before anesthesia,while the MAP and HR of patients in control group were significantly higher than those before anesthesia in 2 h and 4 h,and the SpO2 level of the patients in the two groups was not significant;There was no significant difference between the two groups in the time of anesthesia and operation time,while the observation group was significantly shorter than the control group,the difference was statistically significant（P 〈0.05）;The VAS score of 4 h,12 h and 24 h in the observation group was lower than that of the control group（P 〈0.05）,and there was no difference in the Ramsay score between the two groups（P 〉0.05）;There was no significant difference in the incidence of nausea,vomiting,abdominal distension and cognitive dysfunction between the two groups（χ2=1.569,P =0.210）.ConclusionThe application of tramadol and etomidate in elderly patients with laryngoscopy has a good effect on the hemodynamics of patients,and it has a good application value.