摘要
目的比较不同速度连续输注瑞芬太尼在老年患者全麻诱导中的应用。方法拟下腹部择期手术的老年患者(≥65岁)60例,根据瑞芬太尼输注速度(0.1、0.15、0.2、0.3μg.kg-1.min-1)随机分为4组(n=15),给予咪达唑仑和丙泊酚后,各组按不同速度输注瑞芬太尼,3 min后静注维库溴铵行气管插管。插管后根据血压调整丙泊酚输注速度,切皮前固定丙泊酚输注速度为4 mg.kg-1.h-1。结果各组插管Grant评分均<8分。随瑞芬太尼输注速度增加,阿托品与麻黄素的使用例数明显增加,而丙泊酚的用量减少。瑞芬太尼0.3μg.kg-1.min-1组在瑞芬太尼开始输注后,心率有明显减慢(P<0.05)。插管前后瑞芬太尼0.1和0.15μg.kg-1.min-1组的心率变化有明显差异(P<0.05)。丙泊酚使各组血压下降,输注瑞芬太尼后收缩压进一步下降(P<0.05)。与插管前相比,瑞芬太尼0.1μg.kg-1.min-1组在插管后收缩压有明显上升(P<0.05)。切皮后各组血压均有上升,但仅有瑞芬太尼0.1μg.kg-1.min-1组与切皮前相比有统计学差异(P<0.05)。结论老年患者全麻诱导中,丙泊酚伍用瑞芬太尼时,瑞芬太尼输注速度以0.15-0.2μg.kg-1.min-1比较合理,而且能维持血流动力学稳定。
Objective To study the application of continuous infusion of remifentanil combined with propofol with different velocity during induction of general anesthesia in elderly patients. Methods Sixty elderly patients were divided into 4 groups randomly （n = 15） and given remifentanil with continuous infusion rate of 0.1,0.15,0.2 and 0.3 μg· kg^1 ·min^ -1 , respectively. After given midazolam and propofol, remifentanil infusion started with different velocity. Three minutes later, vecuronium was given and intubation performed 2 min later. After that, propofol infusion rate was adjusted according to the changes of blood pressure and kept at 4 mg· kg^-1 · h^ - 5 min before incision. Blood pressure （BP）, heart rate （HR）, intubation score （following Grant＇s method） and all side effects and adjuvant drugs used were recorded. Results Grant scores in all patients were less than 8. Atropine and ephedrine were given more in large dose groups and with decreasing of usage of propofol. HR decreased markedly in 0.3 μg· kg^1 ·min^ -1 group after remifentanil began （P 〈 0.05） and significant increase was observed in 0.1 and 0.15μg· kg^1 ·min^ -1 groups after intubation （P 〈 0.05）. Propofol lowered the BP and 0.2 and 0.3 μg· kg^1 ·min^ -1 remifentanil accelerated these changes （P 〈 0.05）. Compared with that before intubation, 0.1 μg· kg^1 ·min^ -1 group was of marked increase in systolic blood pressure after intubaion. Though BP was increased in each groups after incision, only 0. 1 μg· kg^1 ·min^ -1 group was found significantly different from that before incision （P 〈 0.05 ）. Conclusion When general intravenous anesthesia with continuous infusion of remifentanil and propofol in elderly patients is performed, the infusion rate of remifentanil shall be controlled between 0.15 - 0.2 μg· kg^1 ·min^ -1, which can maintain a stable hemodynamics.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2007年第4期440-442,共3页
Journal of Shanghai Jiao tong University:Medical Science
关键词
瑞芬太尼
老年
全麻诱导
血流动力学
remifentanil
elder
anesthetic induction
hemodynamics
