摘要
目的 观察靶控输注咪达唑仑镇静时老年手术患者和年轻患者心率变异性（HRV）的变化。方法 38例ASAI～Ⅱ级择期椎管内麻醉下行下肢或下腹部手术患者,分为老年组（60～82岁）和年轻组（18～40岁）,每组19例。采用靶控输注,靶浓度从50ng/ml起渐增,直至病人OAA/S评分为1级。观察镇静起效期和恢复期不同OAA/S评分时,两组HRV参数等的变化。结果 随咪达唑仑镇静程度加深,两组患者LF、nuLF、LF/HF、TP和HRV逐渐降低,nuHF升高,HF无明显改变。随镇静作用减退,HRV参数逐渐恢复至基础值。LF、LF/HF、TP和HRV与镇静评分的相关性较好（r=0.502～0.719）。两组总体变化趋势一致。相同镇静评分时,绝大多数HRV参数值老年组与年轻组无显著性差异,仅在深度镇静（OAA/S1级）时,老年组HRV各值均显著低于年轻组（除外LF/HF）。结论 深度镇静（OAA/S1级）时,咪达唑仑对老年患者自主神经活性的抑制较年轻患者显著,但对没有心血管和自主神经系统疾病的老年手术患者交感-副交感神经均衡性的维持与年轻患者无明显差异。
Objective To assess the changes in heart rate variability (HRV) during midazolam sedation with TCI in the elderly and young patients. Methods Thirty-eight ASA I - Ⅱ patients scheduled for elective surgery on lower abdomen or lower extremities under epidural or combined epidural-spinal anesthesia were divided into two groups of 19 patients each: the young group (18-40 yr) and the elderly group (60-89 yr). Radial artery was cannulated for intra-arterial pressure monitoring and blood sampling. HRV was monitored by HXD-1 monitoring system. HRV parameters included total power (TP), low frequency(LF), high frequency(HF), LF/HF, nuLF(LF/TP ×100%) and NuHF(HF/TP × 100%) . The height of block was maintained below T5. TCI was used to achieve a rapid induction and maintenance of a stable target blood midazolam concentration. Target blood midazolam concentration was started from 50 ng/ml and gradually increased with increment of 25 ng/ml in elderly group or 50ng/ml in the young group until loss of consciousness (OAA/S =1). Arterial blood samples were taken at each target blood midazolam concentration for determination of blood midazolam concentration. HRV parameters were recorded at different OAA/S scores during both the induction of and recovery from sedation. Results With increasing depth of sedation, most of the HRV parameters (LF, nuLF, LF/HF and TP) decreased progressively, while nuHF increased and HF remained unchanged. During recovery from midazolam-induced sedation, HRV parameters returned gradually to the baseline values. OAA/S scores and HRV parameters were well correlated(r = 0.502-0.719). The trend of changes in HRV was consistent in both groups. At the same OAA/S score, most values of HRV parameters were not significantly different between the two groups. Only during deep sedation (OAA/S=1), values of all HRV parameters were significantly lower in the elderly group than those in the young group, except LF/HF. Conclusions During profound sedation (OAA/S=1) midazolam depresses the activity of the autonomic nervous system more markedly in the elderly than in the young, but the elderly without cardiovascular and autonomic nervous system disorders has the same ability to keep the balance between the sympathetic and parasympathetic nervous system as theyoung.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2002年第3期148-151,共4页
Chinese Journal of Anesthesiology
关键词
咪达唑仑
老年人
清醒镇静
心率变异性
靶控输注
年轻人
Aged
Midazolam
Conscious sedation
Heart rate variability
Target controlled infusion
