甲氧明小剂量静脉预注预防老年冠心病患者全身麻醉诱导期低血压的应用研究

Application of Small Dose of Methoxymethine in the Prevention of Hypotension in Induction of General Anesthesia in Elderly Patients with Coronary Heart Disease

目的研究甲氧明小剂量静脉预注预防老年冠心病患者全身麻醉诱导期低血压的应用效果。方法方便选择2017年1月—2018年5月期间在该院接受全身麻醉的60例老年冠心病患者作为观察对象,参照随机数表法分成对照组、研究组,各30例。对照组患者接受无菌生理盐水进行静脉注射,研究组患者给予静脉注射甲氧明以预防低血压的发生。对比两组患者麻醉诱导前后血压、心率变化及不良事件发生率。结果研究组患者麻醉诱导前平均动脉压对比,差异无统计学意义(t=0.505,P>0.05);两组麻醉诱导后1、3、5 min的平均动脉压均下降,麻醉诱导后1 min,实验组平均动脉压是(96.2±2.3)mmHg,诱导后3 min是(95.9±2.6)mmHg,诱导后5 min是(95.5±3.7)mmHg,分别较对照组的诱导后1 min(84.5±2.1)mmHg、诱导后3 min(80.3±2.0)mmHg、诱导后5 min(80.4±2.2)mmHg高,差异有统计学意义(t=20.576、26.048、19.231,P<0.05);麻醉诱导后1、3、5 min两组患者的心率诱导前对比,差异无统计学意义(t=0.107,P>0.05);研究组患者麻醉诱导期低血压发生率6.7%(2/30)低于对照组的26.7%(8/30),差异有统计学意义(χ2=4.320,P<0.05);两组患者的恶心呕吐、心动过缓发生率对比,差异无统计学意义(χ2=0.014、0.000,P>0.05)。结论于老年冠心病患者全身麻醉诱导期静脉预注甲氧明能对低血压反应进行有效对抗,维持血流动力学稳定,降低低血压发生率,值得临床推广。

Objective To investigate the effect of low-dose intravenous pretreatment of methoxymethine on prevention of hypotension during induction of general anesthesia in elderly patients with coronary heart disease. Methods 60 elderly patients with coronary heart disease who underwent general anesthesia from January 2017 to May 2018 were convenient selected and enrolled in the study. They were divided into control group and study group according to random number table method, 30 cases each. Patients in the control group received sterile saline for intravenous injection. Patients in the study group were given intravenous methoxyphene to prevent hypotension. The blood pressure, heart rate and adverse events were compared before and after anesthesia induction between the two groups. Results The mean arterial pressure before anesthesia induction in the study group was not statistically significant(t=0.505, P>0.05). The mean arterial pressure decreased at1, 3, and 5 min after anesthesia induction, 1 min after anesthesia induction. The mean arterial pressure was(96.2 ±2.3)mmHg,(95.9±2.6) mmHg at 3 min after induction, and(95.5±3.7)mmHg at 5 min after induction, which was induced 1 min(84.5±2.1)mmHg after induction. After 3 min(80.3±2.0)mmHg, 5 min after induction(80.4±2.2)mmHg, the difference was statistically significant(t=20.576, 26.048, 19.231, P<0.05);two groups of patients 1, 3, 5 min after induction of anesthesia between heart rate and pre-induction, there was no significant difference(t=0.107, P>0.05). The incidence of hypotension in the induction group was 6.7%(2/30) in the study group, which was lower than 26.7%(8/30) in the control group. The difference was statistically significant(χ2=4.320, P<0.05). There was no significant difference in the incidence of nausea and vomiting and bradycardia between the two groups(χ2=0.014, 0.000, P>0.05). Conclusion In the induction of general anesthesia in elderly patients with coronary heart disease, intravenous pre-injection of methoxyphene can effectively counteract hypotension, maintain hemodynamic stability, and reduce the incidence of hypotension, which is worthy of clinical promotion.