三种阿片类药物全身麻醉诱导对老年患者气管插管反应的影响

摘要

目的 探讨3种阿片类药物芬太尼、瑞芬太尼、舒芬太尼全身麻醉诱导插管对于老年患者血流动力学的影响.方法 选取45例患者随机分为3组,以心率、收缩压、舒张压和平均动脉压(MAP)为观察指标,分别记录3种不同药物诱导插管在入室(T0)、开始诱导(T1)及诱导后1～10 min(T2～T11,T5为喉镜暴露声门,插入气管导管时刻)的心率、收缩压、舒张压、MAP和心率×收缩压(RPP)数值.结果 3组患者收缩压、舒张压、心率、RPP组间比较,差异无统计学意义.各时间点的总体均数差异有统计学意义(P＜0.01).组间与各时间点交互效应差异无统计学意义.各组收缩压在T2～T4、T7～T11与T0时相比差异有统计学意义(P＜0.05).各组患者给诱导药后收缩压均明显下降,插管后即刻(T5)血压迅速上升,但与T0、T1相比,差异无统计学意义.3组患者心率在T6时间点的总体均数差异有统计学意义.RPP值在T6时间点芬太尼组与瑞芬太尼、舒芬太尼组之间差异有统计学意义.结论 对于老年人全身麻醉诱导插管,瑞芬太尼和舒芬太尼能更好地阻断插管刺激,效果更好.%Objective To study the effect of three types of opioids anesthesia induction and intubation on senile patient hemodynamics. Methods Forty-five patients were randomly divided into three groups. HR, SBP, DBP and mean arterial pressure (MAP) were taken as observation indexes. HR, SBP, DBP, MAP and RPP (HR × SBP) values of the three opioids anesthesia induction and intubation at entrance (T0), beginning of the induction (T1) and after induction for 1 ～10 min(T2～T11, T5 stands for the time of glottis exposure to laryngoscopy and tracheal tube insertion) were recorded. Results No significant statistical significance was noted in SBP, DBP, HR, RPP between the three groups.Population mean of each time point showed significant difference (P＜0.01). Interaction effects at each time points between groups had no statistical difference. SBP in T2～T4, T7～T11 in each group was significantly different from that of T0 (P＜0.005). After medicine intake, systolic pressure in patients from each group decreased significantly, and pressure after intubation (T5) increased rapidly, however no statistical difference was noted when comparing with that of T0 and T1.Statistical significance in population means of heart rate at T6 was statistically significant among the three groups. RPP values at T6 in fentanyl group was significantly different from that of remifentanil and sufentanil groups. Conclusions Remifentanil and sufentanil may better inhibit the stimulation of intubation in senile anesthesia induction patients.