CAJ | 학술논문

目的：观察舒芬太尼用于高龄患者全麻诱导气管插管的临床效果。方法选择ASAⅡ～Ⅲ级，需在气管插管全身麻醉下行四肢手术的高龄（年龄≥80岁）患者45例，随机分三组：舒芬太尼0.15μg/kg 组（ S1组）、舒芬太尼0.25μg/kg组（S2组）及芬太尼2μg/kg组（F组），每组15例。所有患者均分别记录基础值（T0）、插管前1 min（T1）、插管后1 min（T2）和插管后5 min（T3）的收缩压（SP）、舒张压（DP）和心率（HR），并计算各时间点 SP 与 HR 的乘积（ RPP）；记录不良反应的发生及药物使用情况。结果三组T1时间点BP和T3时间点SP、S2组T2时间点SP和F组T3时间点DP均显著低于同组T0时间点（P均<0.01），F组T2时间点DP显著高于同组T0时间点（P<0.05）和S2组同时间点（ P<0.05），S1组和S2组T1时间点SP、S2组T2时间点BP均显著低于F组同时间点（ P<0.01或0.05）。S1组和F组T2时间点HR均显著大于同组T0时间点（ P均<0.01）和S2组同时间点（ P<0.05）。三组T1、T3时间点RPP均显著小于同组T0时间点（ P<0.01或0.05）。F组T2时间点RPP显著大于同组T0时间点（ P<0.05）和S2组同时间点（P<0.05）。S2组声带活动发生率、丙泊酚和瑞芬太尼使用率小于S1组，罗库溴铵、新福林使用率均显著小于S1组和F组（P<0.05）。结论舒芬太尼0.25μg/kg用于高龄患者全麻诱导，不仅能抑制插管反应，减少不良反应，而且能保持插管前后心血管功能稳定和心肌氧供需平稳，安全可行。
목적：관찰서분태니용우고령환자전마유도기관삽관적림상효과。방법선택ASAⅡ～Ⅲ급，수재기관삽관전신마취하행사지수술적고령（년령≥80세）환자45례，수궤분삼조：서분태니0.15μg/kg 조（ S1조）、서분태니0.25μg/kg조（S2조）급분태니2μg/kg조（F조），매조15례。소유환자균분별기록기출치（T0）、삽관전1 min（T1）、삽관후1 min（T2）화삽관후5 min（T3）적수축압（SP）、서장압（DP）화심솔（HR），병계산각시간점 SP 여 HR 적승적（ RPP）；기록불량반응적발생급약물사용정황。결과삼조T1시간점BP화T3시간점SP、S2조T2시간점SP화F조T3시간점DP균현저저우동조T0시간점（P균<0.01），F조T2시간점DP현저고우동조T0시간점（P<0.05）화S2조동시간점（ P<0.05），S1조화S2조T1시간점SP、S2조T2시간점BP균현저저우F조동시간점（ P<0.01혹0.05）。S1조화F조T2시간점HR균현저대우동조T0시간점（ P균<0.01）화S2조동시간점（ P<0.05）。삼조T1、T3시간점RPP균현저소우동조T0시간점（ P<0.01혹0.05）。F조T2시간점RPP현저대우동조T0시간점（ P<0.05）화S2조동시간점（P<0.05）。S2조성대활동발생솔、병박분화서분태니사용솔소우S1조，라고추안、신복림사용솔균현저소우S1조화F조（P<0.05）。결론서분태니0.25μg/kg용우고령환자전마유도，불부능억제삽관반응，감소불량반응，이차능보지삽관전후심혈관공능은정화심기양공수평은，안전가행。
Objective To observe the clinical effect of sufentanil on elderly patients with general anesthesia induction of en-dotracheal intubation. Methods Fourty-five patients aged 80 or above with ASAⅡ - Ⅲlevel who needed to be conducted tra-cheal intubation general anesthesia downlink limbs surgery were selected and divided into three groups,with fifteen cases in each group. Group S1 was given 0. 15 μg/kg sufentanil,group S2 was given 0. 25 μg/kg sufentanil and group F was given 2 μg/kg fentanyl. All patients were respectively recorded based value(T0),1 min before intubation(T1),1 min after intubation(T2) and 5 min after intubation(T3)of SP and DP and HR,and calculate the SP at each time point and the product of HR(RPP). The occurrence of adverse reactions and drug use were also recorded. Results BP at T1 time and SP at T3 time of the three groups,SP at T2 time of group S2 and DP at T3 time of group F were significantly lower than the that at T0 time point( P<0. 01),DP at T2 time of group F was significantly higher than that at the T0 time point(P<0. 05)and group S2 at the same time points( P<0. 05),SP of group S1 and group S2 at T1 time point,BP at T2 time point of group S2 were significantly lower than that of group F with time points( respectively P<0. 01,0. 05). HR of group S1 and groups F at T2 time points were signifi-cantly greater than that at the T0 time point(P<0. 01)and group S2 at the same time points(P<0. 05). RPP at T1,T3 points in the three groups were significantly less than that at T0 time points(respectively P<0. 01,0. 05). RPP at T2 time point of group F significantly greater than that at the T0 time points(P<0. 05)and group S2 at the same time points(P<0. 05). Inci-dence of vocal activity,utilization rate of propofol,remifentanil signllificantly of group S2 was less than that of S1 group,rocuro-nium and phenylephrine were significantly less than those of group S1 and F( P<0. 05 ). Conclusion Sufentanil 0. 25 μg/kg for elderly patients with general anesthesia induction can not only restrain intubation response,reduce adverse reactions,and can also maintain stability before and after intubation cardiovascular function and myocardial oxygen supply and demand of steady,is safe and feasible.