国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
10期
877-880,885
,共5页
高亚利%疏树华%王瑞明%柴小青
高亞利%疏樹華%王瑞明%柴小青
고아리%소수화%왕서명%시소청
老年人%七氟烷%瑞芬太尼%诱导%麻醉深度
老年人%七氟烷%瑞芬太尼%誘導%痳醉深度
노년인%칠불완%서분태니%유도%마취심도
Elderly%Sevoflurane%Remifentanil%Induction%Depth of anesthesia
目的 探讨不同浓度七氟烷复合麻醉在老年患者全麻诱导中的合理应用及对麻醉深度的影响. 方法 择期在全麻下行腹部手术的老年患者60例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,采用随机数字表法将患者随机分为4组(每组15例):S1组(吸入4％的七氟烷)；S2组(吸入6％的七氟烷)；S3组(吸入8％的七氟烷)；P组(靶控血浆靶浓度3 mg/L的异丙酚),待各组患者镇静警觉评分(observer's assessment of alertness/sedation,OAA/S)=1后静脉注射瑞芬太尼、罗库溴铵,2 min后行气管插管.记录各组达到意识消失、睫毛反射消失、OAA/S=1的时间及各时点的脑电双频指数(bispectral index,BIS)、听觉诱发电位指数(A-line ARX index,AAI)值；记录诱导前,注入瑞芬太尼前,插管前,插管即刻,插管后1、2、3 min的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、BIS、AAI值. 结果 七氟烷组随着吸入浓度增高,S3组意识消失、睫毛反射消失、OAMS评分=1的时间[(84±5)、(92±5)、(178±9)s]短于S1组[(109±5)、(117±4)、(197±9)s]和S2组[(95±5)、(102±5)、(188±8)s](P＜0.01)；S2组短于S1组(P＜0.01).P组各时点时间[(131±4)、(139±4)、(222±8)s]较S1、S2、S3组延长(P＜0.01).各组诱导后MAP均降至最低,组间比较P组(68.9±2.3) mm Hg(1 mm Hg=0.133 kPa)明显低于S1、S2、S3组[(76.8±6.6)、(75±3)、(75±3) mmHg](P＜0.01).插管后各组MAP均高于插管前,组间比较S1组[(99.3±4.6)、(95.7±4.3)mmHg]在插管后1、2 min高于S2组[(96±5)、(92±4) mm Hg]、S3组[(96±3)、(92±3) mm Hg]、P组[(96.1±3.3)、(92.4±3.4) mm Hg](P＜0.05). 结论 6％、8％七氟烷复合麻醉用于老年人全麻诱导起效快、血流动力学平稳、不增加不良事件发生率,可安全可靠使用.
目的 探討不同濃度七氟烷複閤痳醉在老年患者全痳誘導中的閤理應用及對痳醉深度的影響. 方法 擇期在全痳下行腹部手術的老年患者60例,美國痳醉醫師協會(ASA)分級Ⅰ或Ⅱ級,採用隨機數字錶法將患者隨機分為4組(每組15例):S1組(吸入4％的七氟烷)；S2組(吸入6％的七氟烷)；S3組(吸入8％的七氟烷)；P組(靶控血漿靶濃度3 mg/L的異丙酚),待各組患者鎮靜警覺評分(observer's assessment of alertness/sedation,OAA/S)=1後靜脈註射瑞芬太尼、囉庫溴銨,2 min後行氣管插管.記錄各組達到意識消失、睫毛反射消失、OAA/S=1的時間及各時點的腦電雙頻指數(bispectral index,BIS)、聽覺誘髮電位指數(A-line ARX index,AAI)值；記錄誘導前,註入瑞芬太尼前,插管前,插管即刻,插管後1、2、3 min的平均動脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)、BIS、AAI值. 結果 七氟烷組隨著吸入濃度增高,S3組意識消失、睫毛反射消失、OAMS評分=1的時間[(84±5)、(92±5)、(178±9)s]短于S1組[(109±5)、(117±4)、(197±9)s]和S2組[(95±5)、(102±5)、(188±8)s](P＜0.01)；S2組短于S1組(P＜0.01).P組各時點時間[(131±4)、(139±4)、(222±8)s]較S1、S2、S3組延長(P＜0.01).各組誘導後MAP均降至最低,組間比較P組(68.9±2.3) mm Hg(1 mm Hg=0.133 kPa)明顯低于S1、S2、S3組[(76.8±6.6)、(75±3)、(75±3) mmHg](P＜0.01).插管後各組MAP均高于插管前,組間比較S1組[(99.3±4.6)、(95.7±4.3)mmHg]在插管後1、2 min高于S2組[(96±5)、(92±4) mm Hg]、S3組[(96±3)、(92±3) mm Hg]、P組[(96.1±3.3)、(92.4±3.4) mm Hg](P＜0.05). 結論 6％、8％七氟烷複閤痳醉用于老年人全痳誘導起效快、血流動力學平穩、不增加不良事件髮生率,可安全可靠使用.
목적 탐토불동농도칠불완복합마취재노년환자전마유도중적합리응용급대마취심도적영향. 방법 택기재전마하행복부수술적노년환자60례,미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급,채용수궤수자표법장환자수궤분위4조(매조15례):S1조(흡입4％적칠불완)；S2조(흡입6％적칠불완)；S3조(흡입8％적칠불완)；P조(파공혈장파농도3 mg/L적이병분),대각조환자진정경각평분(observer's assessment of alertness/sedation,OAA/S)=1후정맥주사서분태니、라고추안,2 min후행기관삽관.기록각조체도의식소실、첩모반사소실、OAA/S=1적시간급각시점적뇌전쌍빈지수(bispectral index,BIS)、은각유발전위지수(A-line ARX index,AAI)치；기록유도전,주입서분태니전,삽관전,삽관즉각,삽관후1、2、3 min적평균동맥압(mean arterial pressure,MAP)、심솔(heart rate,HR)、BIS、AAI치. 결과 칠불완조수착흡입농도증고,S3조의식소실、첩모반사소실、OAMS평분=1적시간[(84±5)、(92±5)、(178±9)s]단우S1조[(109±5)、(117±4)、(197±9)s]화S2조[(95±5)、(102±5)、(188±8)s](P＜0.01)；S2조단우S1조(P＜0.01).P조각시점시간[(131±4)、(139±4)、(222±8)s]교S1、S2、S3조연장(P＜0.01).각조유도후MAP균강지최저,조간비교P조(68.9±2.3) mm Hg(1 mm Hg=0.133 kPa)명현저우S1、S2、S3조[(76.8±6.6)、(75±3)、(75±3) mmHg](P＜0.01).삽관후각조MAP균고우삽관전,조간비교S1조[(99.3±4.6)、(95.7±4.3)mmHg]재삽관후1、2 min고우S2조[(96±5)、(92±4) mm Hg]、S3조[(96±3)、(92±3) mm Hg]、P조[(96.1±3.3)、(92.4±3.4) mm Hg](P＜0.05). 결론 6％、8％칠불완복합마취용우노년인전마유도기효쾌、혈류동역학평은、불증가불량사건발생솔,가안전가고사용.
Objective To investigate the reasonable application of different concentrations of sevoflurane inhalation during the induction of combined anesthesia in the elderly and the effect of that on the depth of anesthesia.Methods Sixty ASA Ⅰ or Ⅱ elderly patients who undergoing elective abdominal surgery under endotracheal anesthesia were randomly divided into four groups (n=15).In group Ⅰ,anesthesia was induced with inhalation of 4％ sevoflurane (group S1).In group Ⅱ,anesthesia was induced with inhalation of 6％ sevoflurane (group S2).In group Ⅲ,anesthesia was induced with inhalation of 8％ sevoflurane (group S3).In group Ⅳ,anesthesia was induced with target plasma concentration of 3 mg/L propofol (group P).Remifentanil and rocuronium were administered iv after alertness/sedation scale(OAA/S)=1 in all 4 groups,tracheal intubation was performed 2 min later.Duration from the start of induction to loss of consciousness and eyelash reflex,duration from the start of induction to OAMS =1,electroencephalogram bispectral index (BIS) and A-line ARX index (AAI) at corresponding points were recorded.Mean arterial pressure (MAP),heart rate (HR),BIS,AAI value at time of before induction,before administration of remifentanil,before intubation,tracheal intubation,1,2,3 min after intubation were recorded.Results Time to loss of consciousness,loss of eyelash reflex,OAA/S=1 in group S3 [(84±5),(92±5),(178±9) s] were significantly shorter than that in group S1 [(109±5),(117±4),(197±9) s] and S2[(95±5),(102±5),(188±8) s](P＜0.01),time in group S2 at corresponding points were significandy shorter than that in group S1 (P＜0.01),time in group P[(131±4),(139±4),(222±8) s] at corresponding points were significantly longer than that in groups S1,S2 and S3(P＜0.01).MAP in all groups reduced to the lowest value after induction,MAP in group P(68.9±2.3) mm Hg (1 mm Hg=0.133 kPa) was more lower than that in groups S1,S2 and S3 [(76.8±6.6),(75±3),(75±3) mm Hg](P＜0.01).MAP in all groups after tracheal intubation were higher than that before wacheal intubation,and MAP in group S1 [(99.3±4.6),(95.7±4.3) mm Hg]were higher than that in group S2[(96±5),(92±4) mm Hg],group S3[(96±3),92±3)mm Hg],group P[(96.1±3.3),(92.4±3.4) mmn Hg]at 1,2 min after tracheal intubation (P＜0.05).Conclusions Induction with 6％ or 8％ sevoflurane combined anesthesia in the elderly can provide rapid onset time,hemodynamic stability and can be used safely without increasing the incidence of adverse events.
