不同剂量瑞芬太尼联合丙泊酚靶控输注对老年全麻患者应激反应和血流动力学的影响研究

Effects of different doses of remifentanil combined with propofol target-controlled infusion on stress response and hemodynamics in elderly patients with general anesthesia

目的:探究不同剂量瑞芬太尼联合丙泊酚靶控输注对老年全麻患者应激反应和血流动力学的影响。方法:纳入全麻手术老年患者180例,按照随机数字法分为A组、B组和C组各60例。三组患者均进行丙泊酚靶控输注,并进行瑞芬太尼的静脉注射,其中A组输注剂量为1.0μg/kg,B组为2.0μg/kg,C组为3.0μg/kg。比较三组患者T0~T3时的血流动力学相关指标,T0、T2和T3时肾上腺素和去甲肾上腺素的水平以及不良反应发生率。结果:B组MAP在T0、T1、T2和T3时,明显高于A组同时间点(P<0.05)。C组在T1、T2和T3时的MAP均明显高于A组同时间点(P<0.05),在T1、T2时的RR明显高于A组同时间点(P<0.05)。与A组相比,B组和C组T2时肾上腺素和去甲肾上腺素水平变化比较差异无统计学意义(P>0.05),T3时肾上腺素和去甲肾上腺素水平均明显降低(P<0.05)。B组呛咳发生率明显低于A组(P<0.05),C组躁动、呛咳发生率均明显低于A组(P<0.05),C组低血压、心动过缓发生率均明显高于A组(P<0.05)。结论:瑞芬太尼剂量为2.0μg/kg时,联合丙泊酚靶控输注更易维持老年全麻患者血流动力学的稳定,降低气管插管引起的应激反应,且安全性好。

Objective:To study the effects of different doses of remifentanil combined with propofol target-controlled infusion on stress response and hemodynamics in elderly patients with general anesthesia.Methods:180 elderly patients were divided into group A,group B and group C according to the random number method,with 60 cases in each group.Target-controlled infusion of propofol and intravenous remifentanil were administered to all three groups of patients.The infusion dose was 1.0μg/kg in group A,2.0μg/kg in group B,and 3.0μg/kg in group C.The hemodynamic related indexes at T 0-T 3,the levels of epinephrine and norepinephrine at T 0,T 2,and T 3,and the incidence of adverse reactions were compared.Results:The MAP of group B at T 0,T 1,T 2 and T 3 was significantly higher than that of group A at the same time point(P<0.05).The MAP of group C at T 1,T 2 and T 3 was significantly higher than that of group A at the same time point(P<0.05),and the RR at T 1 and T 2 was significantly higher than that of group A at the same time point(P<0.05).Compared with group A,there was no significant difference in the levels of epinephrine and norepinephrine at T 2 between group B and C(P>0.05),and the levels of epinephrine and norepinephrine at T 3 were significantly lower(P<0.05).The incidence of choking in group B was significantly lower than that in group A(P<0.05).The incidence of agitation and choking in group C were significantly lower than those in group A(P<0.05).The incidence of hypotension and bradycardia in group C were significantly higher than those in group A(P<0.05).Conclusion:When the remifentanil dose is 2.0μg/kg,target-controlled infusion of propofol is easier to maintain hemodynamic stability,reduce the stress response caused by tracheal intubation,and has good safety.