靶控输注雷米芬太尼复合依托咪酯对老年患者全麻诱导期血流动力学的影响

摘要

目的 研究靶控输注(TCI)雷米芬太尼和依托咪酯诱导对老年患者血流动力学的影响.方法 60例择期老年手术患者均分为三组:诱导用依托咪酯TCI靶浓度均为0.6μg/ml；雷米芬太尼靶浓度分别为2 ng/ml(L组)、4 ng/ml(M组)和6 ng/ml(H组).记录麻醉前(T1)、气管插管前(T2)、插管后1 min(T3)和5 min(T4)时点的MAP、HR、每搏指数(SI)、心脏指数(CI)、全身血管阻力指数(SVRI)、加速指数(ACI)值.结果 在T2时点,三组MAP、HR、SI、CI、SVRI、ACI均比T1时明显降低(P＜0.05),且H组较L、M组变化明显.在T3、T4时,L组HR、MAP、SVRI明显高于M和H组(P＜0.05),而H组CI、SI、ACI明显低于L和M组(P＜0.05).结论 以靶浓度雷米芬太尼4 ng/ml复合依托咪酯0.6μg/ml TCI麻醉诱导能较好地减轻老年患者气管插管的应激反应,维持血流动力学稳定.%Objective To investigate the effect of target-controlled infusion(TCI) of etomidate and remifentanil during anesthesia induction on the hemodynamics in the elderly. Methods Sixty surgical patients aged 65 to 75 years old were equally divided into three groups. Anesthesia induction was performed with TCI of etomidate in a target concentration of 0. 6 μg/ml plus TCI remifentanil in a target concentration of 2 ng/ml(group L),4 ng/ml(group M) or 6 ng/ml(group H). Mean arterial pressure (MAP), heart rate(HR), stroke index (SI), cardiac index (CI), systemic vascular resistance index(SVRI),accelerated index(ACI) were recorded before anesthesia(Tl),before intubation(T2),at 1 min(T3) and 5 min(T4) after intubation. Results MAP, HR,SI,CI,SVRI and ACI were lower at T2 than those at Tl in three groups(P<0. 05), which were lower in group H than those in groups of L and M(P<0. 05). At T3 and T4, HR,MAP and SVRI were higher in group L than those in groups of M and H(P<0. 05) ,but CI,SI and ACI were lower in group H than those in groups of L and M (P<0. 05). Conclusion As for anesthesia induction with combined TCI remifentanil and etomidate, the target concentrations of 4 ng/ml for remifentanil and 0. 6 μg/ml for etomidate are suitable in attenuating intubation-induced stress response and maintaining stable hemodynamics in the elderly.