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老年人丙泊酚靶控输注和七氟醚吸入诱导对血流动力学的影响
COMPARISON OF THE EFFECTS OF PROPOFOL INTRAVENOUS TARGET-CONTROLLED INFUSION AND SEVOFLURANE INHALED ON HEMODYNAMIC CHANGES DURING INDUCTION IN ELDERLY

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DOI:
作者:
黄萍，周颖，张洁，王珊娟，杭燕南
Huang Ping，Zhou Ying，Zhang Jie，Wang Shanjuan
作者单位:
上海市交通大学附属仁济医院麻醉科
Department of Anesthesiology，Renji Hospital，Shanghai Jiaotong University School of Medicine， Shanghai 200001，China
关键词:
丙泊酚，七氟醚，无创血流动力学，靶控输注，老年人
Propofol, Sevoflurane, Target-controlled infusion, Noninvasive hemodynamics，Elderly patients
摘要:
【摘要】目的 丙泊酚和七氟醚是目前临床常用的静脉和吸入麻醉药，广泛用于临床麻醉。本研究以BIS作为麻醉镇静深度监测指标，采用BioZ.com®无创血流动力学监测仪探讨老年人丙泊酚靶控输注和七氟醚吸入诱导对血流动力学的影响。方法 选择全麻气管插管的择期腹部手术老年患者40例，年龄65岁以上，ASA I～II级。随机分为丙泊酚组（Pro组，n=20），采用血浆浓度3 μg/ml靶控输注诱导；七氟醚组（Sev组，n=20），采用4%七氟醚+O2 6L/min吸入诱导。待BIS下降到70以下时，静注罗库溴铵0.6mg/kg和芬太尼3μg/kg。当BIS稳定于45～55之间，进行气管插管操作。诱导全程采用BIS监测麻醉镇静深度；BioZ.com®无创血流动力学监测仪记录基础值（T1）、诱导后2min（T2）、插管前1min（T3）、插管即刻（T4）、插管后1min（T5）、插管后3min（T6）各时间点的无创心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心输出量（CO）、体循环血管阻力（SVR）、左室做功（LCW）指标的变化。结果 诱导后，T2～T4期间各血流动力学参数均呈下降趋势。两组SBP、DBP、MAP、SVR、LCW在T2～T4期间下降最为明显，T4降至最低，T5出现回升，但均未超过基础值；与T4相比，T5时刻差异具有统计学意义（P<0.05）。HR、CO呈缓降趋势。HR在T2、T4、T6时刻S组下降幅度大于P组，但T5反跳小于P组，差异有统计学意义（P<0.05）。结论 BioZ.com®无创血流动力学监测发现丙泊酚靶控输注和七氟醚吸入诱导均能安全有效地用于老年患者全麻诱导和气管插管。
【Abstract】Objective Propofol and Sevoflurane are widely used in clinical anesthesia induction and maintenance. This research compares the different effects of propofol target-controlled infusion and sevoflurane inhaled on hemodynamics with BioZ.com® , noninvasive hemodynamic monitor, while BIS was used as sedative monitor in the elderly patients during anesthesia induction. Methods Fourty elderly patients ASA I~II patients were divided into group propofol (group P, n=20) and group sevoflurane (group S, n=20). After an intravenous injection of midazolam (0.02mg/kg), the patients in group P received a plasma concentration of 3μg/ml of propofol target-controlled infusion induction, and the patients in group S received 4% sevoflurane with oxygen (6L/min). When BIS decreased below 70, rocuronium (0.6mg/kg) and fentanyl (3μg/kg) were given. To maintain BIS within 50±5, trachael intubation was manipulated. The hemodynamic parameters at baseline (T1), 2 min after induction (T2), 1min before intubation (T3), intubation time (T4), 1min after intubation (T5) and 3min after intubation (T6) during induction of general anesthesia in four subgroups were recorded by BioZ.com® which was the noninvasive hemodynamic and cardiac function monitoring system. The parameters included heart rate (HR), systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR) and left cardiac work (LCW). Results All parameters reduced at three time points (T2, T3, T4) during anesthesia induction. SBP, DBP, MAP, SVR, LCW in four subgroups declined to the minimum at T4, and rose at T5, but below the baseline. Compared with T4, SBP, DBP, MAP, SVR, LCW in four subgroups at T5 increased significantly (P<0.05). HR, CO decreased slowly in four subgroups. Compared with group P, the HR of group S declined significantly at three time points (T2, T4, T6), but increased less at T5 (P<0.05). Conclusions The target-controlled infusion of propofol and sevoflurane inhaled can be used safely and effectively during anesthesia induction and intubation in elderly patients via Bioz.com@noninvasive hemodynamic monitor.

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