不同靶控浓度舒芬太尼复合依托咪酯对高龄患者气管插管时血流动力学的影响

摘要

目的 比较靶控输注(TCI)不同效应室质量浓度舒芬太尼复合依托咪酯对高龄患者气管插管时血流动力学的影响.方法 拟行全身麻醉气管插管的高龄患者49例,年龄75 ～90岁,美国麻醉医师协会分级Ⅰ～Ⅲ级,根据舒芬太尼的不同效应室质量浓度随机分为3组:Ⅰ组0.30 μg·L-,Ⅱ组0.35 μg·L-1,Ⅲ组0.40 μg·L-1,首先TCI舒芬太尼,待效应室和血浆质量浓度达平衡时,以0.50 mg·L-1的血浆质量浓度TCI依托咪酯,意识消失后静脉推注顺阿曲库铵,待依托咪酯血浆和效应室质量浓度达平衡时行气管插管,观察并记录诱导前(T0)、舒芬太尼达平衡时(T1)、依托咪酯达平衡时(T2)、插管即刻(T3)、插管后1 min(T4)、插管后3 min(T5)、插管后5 min(T6)的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)、心排出量(CO)、心脏指数(CI)、每搏输出量(SV)的变化.结果 T1和T2时点Ⅲ组HR显著低于Ⅰ组和Ⅱ组(P＜0.05),CO和SV显著高于Ⅰ组和Ⅱ组(P＜0.05)；T3、T4和T5时点Ⅰ组MAP、HR、CO、CI和SV均显著高于Ⅱ组和Ⅲ组(P＜0.05)；T6时点Ⅲ组MAP、HR、CO、CI、SV显著低于Ⅰ组(P＜0.05)；T3和T4时点Ⅰ组MAP、HR、CO、CI、SV显著高于To时点,Ⅱ组和Ⅲ组CO和CI高于To时点(P＜0.05).结论 舒芬太尼效应室质量浓度为0.35 μg·L-1复合依托咪酯血浆质量浓度为0.50 mg·L-1TCI时,对高龄患者全身麻醉诱导时的血流动力学影响最小,较适宜高龄患者气管插管.%Objective To compare the effect on hemodynamics from different effect-site concentrations of sufentanil combined with etomidate by target controlled infusion(TCI) during induction of general anesthesia for elderly patients. Methods Forty-nine elderly patients (75 -90 years old) with the grade of American Society of Anesthesiologists (ASA) Ⅰ — Ⅲ undergoing general anesthesia were randomly divided into three groups. Each group received a fixed sufentanil effect-site concentration of 0.30 μg·L-1 (group Ⅰ ) ,0. 35 μg·L-1 (group Ⅱ )and 0.40 μg·L-1 ( group Ⅲ). The sufentanil between plasma concentration(Cp)and target effect-site concentration (Ge) was administered by TCI in the three groups at the beginning. Then etomidate was used by TCI at the plasma concentration of 0. 50 mg·L-1 .At the moment of loss of consciousness in patients, cisatracurium was administered. Tracheal intubation was performed after the balance of etomidate level between Cp and Ce. Mean arterial pressure (MAP), heart rate (HR ) , bispectral index (BIS), cardiac output ( CO ) , cardiac index (CI) , stroke volume (SV) were recorded at the following time points: before anesthesia(T0) ,the balance of Ce and Cp with sufentanil ( T1) , the balance of Cp and Ce with etomidate(T2) ,at intubation(T3) ,at 1 min(T4) ,3 min(T5) and 5 min(T6) after intubation. Results HR of group Ⅲ was lower significantly than that of group Ⅰ and group Ⅱ at T1 and T2 ( P < 0. 05 ) , however, CO and SV of group Ⅲ were higher significantly than those of group Ⅰ and group Ⅱ ( P < 0. 05 ). MAP, HR, CO, CI, SV of group Ⅰ were higher significantly than those of group Ⅱ and Ⅲ at T3 ,T4 and T5. MAP,HR,CO,CI,SV of group Ⅲ were lower significantly than those of group Ⅰ at T6(P<0.05).At T3 and T4,MAP,HR,CO,CI,SV of group Ⅰ and CO, CI of group Ⅱ and Ⅰ were higher significantly than those at T0 (P < 0.05). Conclusion The hemodynamic of elderly patients in general anesthesia is the most stable, when the mixtured sufentanil in effect-site concentration 0. 35 μg·L-1 and the plasma concentration of etomidate in 0. 50 mg·L-1 , which is suitable for tracheal intubation of elderly patients.