预注多巴胺对老年患者短小手术全麻诱导期血流动力学的影响

Effect of dopamine pre-injection on hemodynamics during induction of general anesthesia in elderly patients with minor surgery

目的观察多巴胺对老年患者短小手术(不含胃、肠镜检查)全身麻醉诱导期维持血流动力学稳定的有效性。方法将60例患者随机分成胶体液组(C组)和多巴胺组(D组),每组30例。麻醉诱导:舒芬太尼0.3~0.5μg/kg、丙泊酚1.5~2mg/kg、罗库溴铵0.6~1mg/kg。C组在诱导前先按10ml/kg预输胶体液,30min内输完;D组在全身麻醉诱导前,静脉注入2~10μg/kg多巴胺。分别观察诱导前(T0),诱导后2min(T1),气管插管时(T2),气管插管后1min(T3),气管插管后3min(T4),气管插管后5min(T5)时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)的变化。结果与T0比较,C组T1、T2和T5时SBP、DBP和MAP明显降低,HR明显升高,而T3时SBP、DBP、MAP和HR均显著升高,差异有统计学意义(P<0.05),D组T1~T5各时间点SBP差异无统计学意义(P>0.05),T1、T2时DBP、MAP和HR均明显降低,差异有统计学意义(P<0.05);与C组比较,D组T1、T2和T5时SBP显著升高,而T3时则显著下降(P<0.05),D组T1~T4时DBP显著降低,T5时显著升高(P<0.05),HR在T1、T3和T4时均降低(P<0.05)。结论全身麻醉诱导时预先输注多巴胺,通过血管收缩作用可以有效维持血流动力学的稳定,效果优于预先扩充循环容量。

Objective To observe the effect of dopamine on hemodynamic stability during induction of general anesthesia in elderly patients undergoing minor surgery(excluding gastroscopy and colonoscopy).Methods 60 patients were randomly divided into colloidal solution group(group C)and dopamine group(group D),30 cases in each group.Anesthesia induction:sufentanil 0.3~0.5μg/kg,propofol 1.5~2mg/kg,rocuronium 0.6~1mg/kg.Group C was infused with 10ml/kg colloidal solution before induction,and group D was infused with 2~10μg/kg dopamine intravenously before induction of general anesthesia.The systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and heart rate(HR)were observed before induction(T0),2min after induction(T1),during tracheal intubation(T2),1min after tracheal intubation(T3),3min after tracheal intubation(T4),and 5min after tracheal intubation(T5).Results Compared with T0,the SBP,DBP and MAP at T1,T2,and T5 in group C were significantly lower,HR was significantly higher,while SBP,DBP,MAP and HR at T3 were significantly increased(P<0.05),there was no significant difference in SBP at T1~T5 in group D(P>0.05),but DBP,MAP and HR were significantly decreased at T1,T2 in group D(P<0.05),compared with group C,SBP in group D was significantly increased at T1,T2 and T5,but decreased at T3(P<0.05),DBP in group D was significantly decreased at T1~T4,significantly increased at T5(P<0.05),and HR was decreased at T1,T3 and T4(P<0.05).Conclusion During the induction of general anesthesia,pre-injection of dopamine can effectively maintain the stability of hemodynamics through vasoconstriction,and the effect is better than pre-expansion of circulation capacity.