目的 观察丙泊酚复合不同剂量瑞芬太尼对老年高血压患者全麻诱导应激反应的影响.方法 将择期行全麻插管下上腹部手术的102例老年高血压患者随机分为丙泊酚2.0 mg/kg+瑞芬太尼1.0μg/kg组(R1组)、丙泊酚2.0 mg/kg+瑞芬太尼2.0μg/kg组(R2组)和丙泊酚2.0 mg/kg+瑞芬太尼3.0μg/kg组(R3组),每组各34例.记录3组麻醉诱导前(t0)、插管前(t1)、插管后即刻(t2)、插管后3 min(t3)和插管后5 min(t4)的血流动力学指标及不良事件发生情况,检测t0、t2、t3、t4时间点血浆皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)水平.结果 R1组t1、t4时间点SBP、DBP及MAP均明显低于t0时间点(P均<0.05),t2、t3时间点SBP、DBP、MAP及HR均明显高于t0时间点(P均<0.05);R2组和R3组t1时间点SBP、DBP、MAP及HR均明显低于t0时间点(P均<0.05),t2时间点MAP及HR均明显高于t0时间点(P均<0.05);R1组t3时间点SBP、DBP、MAP及HR均明显高于R2组和R3组(P均<0.05),而t 4时间点SBP、DBP、MAP均明显低于R 2组和R 3组(P均<0.05),HR明显高于R2组和R3组(P均<0.05).R 1组t 2、t 3时间点和R 2组、R3组t2时间点的血浆Cor浓度均明显高于t0时间点(P均<0.05),R1组t2~t4时间点、R2组和R3组t2时间点的血浆NE及N浓度均明显高于t0时间点(P均<0.05),R2组和R3组t4时间点的血浆Cor浓度均明显低于R1组(P均<0.05),R2组和R3组t3、t4时间点的血浆NE及N浓度均明显低于R1组(P均<0.05).R1组呛咳的发生率明显高于R2组和R3组(P均<0.05),R3组心动过缓、肌僵的发生率明显高于R2组和R1组(P均<0.05).3组心血管活性药物麻黄碱、阿托品、艾司洛尔使用率比较差异均无统计学意义(P均>0.05),R2组和R3组乌拉地尔使用率均明显低于R1组(P均<0.05).结论 静脉注射丙泊酚2.0 mg/kg复合瑞芬太尼2.0μg/kg有利于维持老年高血压患者全麻诱导气管插管时血流动力学稳定,并能很好地抑制插管后心血管不良反应.%Objective It is to observe the effects of propofol combined with different doses of remifentanil on the stress re -sponse induced by general anesthesia in elderly patients with hypertension .Methods 102 elderly patients with hypertensionwere selected and randomly divided into propofol 2.0 mg/kg plus remifentanil 1.0μg/kg group (R1 group), propofol 2.0 mg/kg plus remifentanil 2.0 μg/kg group (R2group)and propofol 2.0 mg/kg plus remifentanil 3.0 μg/kg group (R3group), there were 34 patients in each group .The hemodynamic parameters at different time points of before induction ( t0) , before in-tubation ( t 1) , immediately after intubation ( t2 ) , 3 min after intubation ( t3 ) and 5 min after intubation ( t4 ) , and occurrence of adverse events were recorded in the two groups .The levels of plasma cortisol (Cor), norepinephrine (NE), and epineph-rine ( E) in t0 , t2 , t3 and t4 time points were compared .Rseults Compared with t 0 time point, SBP, DBP and MAP at t 1, t 4 time point were significantly decreased but SBP , DBP,MAP and HR at t 2, t 3 time points were significantly increased in R 1 group (all P<0.05).SBP, DBP, MAP and HR at t 1 time point were significantly lower , but HR and MAP at t 2 time points were significantly higher than those at t0 time points in R2 group and R3 group (all P<0.05).SBP, DBP, MAP and HR at t3 time points were significantly higher , and HR at t4 time point was significantly higher , but SBP, DBP, MAP at t4 time point were significantly lower in R1 group than those in R2 group and R3 group (all P<0.05).The plasma Cor concentration in R1 group at t2 ~t3 time points, and in R2 group and R3 group at t2 time point were significantly higher than those at t0 time point (all P<0.05), the plasma NE and N concentrations in R1 group at t2 ~t4 time points, in R2group and R3 group at t2 time points were significantly higher than those at t0 time point (all P<0.05).The plasma Cor concentration in R 2 group and R3 group were significantly lower than those in R1 group (all P<0.05), the plasma NE and N concentrations in R2 group and R3 group were significantly lower than those in R1 group (all P<0.05).the incidence of cough in R1 group was significantly higher than that in group R2 and group R3(P<0.05), and the incidence of bradycardia and muscle stiff in group R 3 were sig-nificantly higher than those in R2 group and R1 group (P<0.05).Urapidil use rate of R2 group and R3 group were significant-ly lower than that of R1 group (all P<0.05).Conclusion Intravenous propofol 2.0 mg/kg combined with remifentanil 2.0μg/kg is beneficial to maintain hemodynamic stability in elderly patients with high blood pressure during general anesthesia in -duction tracheal intubation , and can be very good inhibition of cardiovascular adverse reactions after intubation .
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