浙江临床医学
浙江臨床醫學
절강림상의학
ZHEJIANG CLINICAL MEDICAL JOURNAL
2014年
2期
208-210,211
,共4页
许先成%王贤裕%冯慧%高美玲%吴艳琼
許先成%王賢裕%馮慧%高美玲%吳豔瓊
허선성%왕현유%풍혜%고미령%오염경
七氟醚依托咪酯%老年%腹部手术%心血管系统
七氟醚依託咪酯%老年%腹部手術%心血管繫統
칠불미의탁미지%노년%복부수술%심혈관계통
Sevoflurane Etomidate%Senium%Abdominal operation%Cardio-vascular system
目的:探讨七氟醚和依托咪酯用于麻醉诱导时对老年腹部手术患者心血管系统的影响。方法40例ASAⅠ~Ⅱ级择期行腹部手术老年患者,随机分成七氟醚组(S组)和依托咪酯组(E组),各20例,全麻诱导均采用咪达挫仑0.03mg/kg、芬太尼3μg/kg、顺苯阿曲库氨0.2mg/kg,在此基础上S组用6%的七氟醚,E组用0.3mg/kg完成麻醉诱导。记录5个时间点(T0为入手术室时,T1为插管即刻,T2为插管后1、2、3min,T3为插管后5min,T4为插管后10min)的血流动力学指标(DBP、SBP、HR),T0、T1、T2时间点自主神经活动指标(IF,HF,IF/HF),以及激素水平变化指标(Ald,ACTH,Cor)。结果两组T0和T1时点SBP、DBP均呈下降趋势,而HR略上升,T2时点E组SBP、DBP、HR较T1时点分别上升36%、70%、30%,较T0时点分别升高11%、29%、44%,差异均有统计学意义(P<0.05),而S组与T0时点基本持平;两组T3、T4时点差异均无统计学意义。两组T0、T1时点LF、HF、LF/HF差异均无统计学意义,同一组患者二时间点相比LF、HF均为2%左右的小幅度波动;T2时点两组3项指标均差异有统计学意义(P<0.05),E组LF、HF、LF/HF较T1时点分别上升24%、下降11%、上升41%,S组分别上升6%、下降1%、上升7%。两组T0时点Cor、ACTH、Ald血液浓度差异均无统计学意义,T1、T2时点差异有统计学意义(P<0.05),E组Cor水平T2时点较T0时点下降35%、ACTH上升46%、Ald下降34%,而S组Cor上升7%、ACTH上升16%、Ald上升4%。结论单纯依托咪酯复合其他麻醉基础药并不能有效抑制插管刺激引起的应激刺激,特别是对老年人的收缩压、心率有较大影响;七氟醚对抑制有害刺激和保持血流动力学稳定性有一定优势。
目的:探討七氟醚和依託咪酯用于痳醉誘導時對老年腹部手術患者心血管繫統的影響。方法40例ASAⅠ~Ⅱ級擇期行腹部手術老年患者,隨機分成七氟醚組(S組)和依託咪酯組(E組),各20例,全痳誘導均採用咪達挫崙0.03mg/kg、芬太尼3μg/kg、順苯阿麯庫氨0.2mg/kg,在此基礎上S組用6%的七氟醚,E組用0.3mg/kg完成痳醉誘導。記錄5箇時間點(T0為入手術室時,T1為插管即刻,T2為插管後1、2、3min,T3為插管後5min,T4為插管後10min)的血流動力學指標(DBP、SBP、HR),T0、T1、T2時間點自主神經活動指標(IF,HF,IF/HF),以及激素水平變化指標(Ald,ACTH,Cor)。結果兩組T0和T1時點SBP、DBP均呈下降趨勢,而HR略上升,T2時點E組SBP、DBP、HR較T1時點分彆上升36%、70%、30%,較T0時點分彆升高11%、29%、44%,差異均有統計學意義(P<0.05),而S組與T0時點基本持平;兩組T3、T4時點差異均無統計學意義。兩組T0、T1時點LF、HF、LF/HF差異均無統計學意義,同一組患者二時間點相比LF、HF均為2%左右的小幅度波動;T2時點兩組3項指標均差異有統計學意義(P<0.05),E組LF、HF、LF/HF較T1時點分彆上升24%、下降11%、上升41%,S組分彆上升6%、下降1%、上升7%。兩組T0時點Cor、ACTH、Ald血液濃度差異均無統計學意義,T1、T2時點差異有統計學意義(P<0.05),E組Cor水平T2時點較T0時點下降35%、ACTH上升46%、Ald下降34%,而S組Cor上升7%、ACTH上升16%、Ald上升4%。結論單純依託咪酯複閤其他痳醉基礎藥併不能有效抑製插管刺激引起的應激刺激,特彆是對老年人的收縮壓、心率有較大影響;七氟醚對抑製有害刺激和保持血流動力學穩定性有一定優勢。
목적:탐토칠불미화의탁미지용우마취유도시대노년복부수술환자심혈관계통적영향。방법40례ASAⅠ~Ⅱ급택기행복부수술노년환자,수궤분성칠불미조(S조)화의탁미지조(E조),각20례,전마유도균채용미체좌륜0.03mg/kg、분태니3μg/kg、순분아곡고안0.2mg/kg,재차기출상S조용6%적칠불미,E조용0.3mg/kg완성마취유도。기록5개시간점(T0위입수술실시,T1위삽관즉각,T2위삽관후1、2、3min,T3위삽관후5min,T4위삽관후10min)적혈류동역학지표(DBP、SBP、HR),T0、T1、T2시간점자주신경활동지표(IF,HF,IF/HF),이급격소수평변화지표(Ald,ACTH,Cor)。결과량조T0화T1시점SBP、DBP균정하강추세,이HR략상승,T2시점E조SBP、DBP、HR교T1시점분별상승36%、70%、30%,교T0시점분별승고11%、29%、44%,차이균유통계학의의(P<0.05),이S조여T0시점기본지평;량조T3、T4시점차이균무통계학의의。량조T0、T1시점LF、HF、LF/HF차이균무통계학의의,동일조환자이시간점상비LF、HF균위2%좌우적소폭도파동;T2시점량조3항지표균차이유통계학의의(P<0.05),E조LF、HF、LF/HF교T1시점분별상승24%、하강11%、상승41%,S조분별상승6%、하강1%、상승7%。량조T0시점Cor、ACTH、Ald혈액농도차이균무통계학의의,T1、T2시점차이유통계학의의(P<0.05),E조Cor수평T2시점교T0시점하강35%、ACTH상승46%、Ald하강34%,이S조Cor상승7%、ACTH상승16%、Ald상승4%。결론단순의탁미지복합기타마취기출약병불능유효억제삽관자격인기적응격자격,특별시대노년인적수축압、심솔유교대영향;칠불미대억제유해자격화보지혈류동역학은정성유일정우세。
Objective To discuss the impact of the induction of anaesthesia by using sevoflurane or etomidate to the elderly patients,cardiovascular system who were undergoing abdominal operations.Methods 40 cases of selected elderly patients with abdominal operations,ASAⅠ~Ⅱlevel,were randomly divided into two groups:Etomidate group(group E,n=20),Sevoflurane group(group S,n=20).The induction of anesthesia are as follows:Two groups were in turn injected midazolam 0.03mg/kg,fentanyl 3μg/kg,etomidate 0.3mg/kg or inhaled sevoflurane 6%. cisatracurium besilate 0.2mg/kg.Recording the hemodynamic parameters of two groups:DBP,SBP, HR at 5 moments(T0,T1,T2,T3,T4);autonomic nerve activity index:IF,HF,IF/HF at 3 moments(T0,T1,T2);changes of hormone levels:Ald.ACTH,Cor at T0,T1,T2. Resluts Hemodynamic parameters:The SBP,DBP of two groups were in a small downtrend at T0,T1.HR rose little.It has no statistical significance(P>0.05).The SBP,DBP,HR of group E at T2 increased by 36%, 70%,30%compared with T1,and increased by 11%,29%,44%compared with T2,group S were at the level of T0 It had no statistical significance(P>0.05)at T3 and T4. Autonomic nerve activity index:LF,HF,LF/HF had no statistical significance between two groups at T0 and T1(P>0.05),but a small amplitude fluctuation about 2%.At T2 there is a statistical significance between two groups.The LF,LF/EF of group E compared T1 increased by 24%,41%,HF decreased by 11%.The same index of group S increased by 6%,7%,decreased by 7%. Changes of hormone levels:Cor,ACTH,Ald had no statistical significance(P>0.05)at T0,but at T1 it is opposite. At T2 Cor, Ald of group E decreased by 35%,34%,ACTH increased by 46%. Cor,ACTH,Ald increased by 7%,16%,4%. Conclusion Only etomidate combined other narcotic basal medicine can not inhibit the stress induced by intubation,especially it has a great influence on systolic pressure and heart rate. which is detrimental to the organ blood supply,and much easier leading to cardiovascular and cerebrovascular accident. Sevoflurane has a certain advantage of inhibiting noxious stimulation and keeping hemodynamic stability,can be further attempted in abdominal operation of the old.