摘要
目的：研究比较舒芬太尼与瑞芬太尼靶控输注对老年患者全麻诱导过程中应激反应的影响。方法：选择择期全麻手术老年患者40例，年龄在65～75岁，分为舒芬太尼（S）组和瑞芬太尼（R）组，每组20例。采用靶控分步输注，调节丙泊酚使脑电双频指数（BIS）保持在60以下。记录所有患者入室后（T0）、诱导后插管前即刻（T1）、插管时（T2）、插管后1min（L）、插管后3min（T4）、插管后5min（T5）、插管后10min（T6）的SBP、DBP、HR、BIS等指标，分别于T0、T3、T5、T6四个时间点采集静脉血测皮质醇血清含量。结果：两组间的SBP、DBP、HR、BIS、皮质醇、总体差异无统计学意义（P〉0．05）；各时间点间比较，麻醉诱导后两组SBP、DBP均呈下降趋势，与基础值（T0）相比差异有统计学意义（P〈0．05），皮质醇先升后降，与T0相比差异有统计学意义（P〈0．05）；各时间点与组间交互效应，只有SBP有统计学意义，两组随时间变化趋势不同，R组在气管插管后5min回落到诱导后插管前水平，S组在气管插管3min即回落到诱导后插管前水平。结论：舒芬太尼和瑞芬太尼通过TCI均能较好地抑制全麻诱导时老年患者气管插管所造成的应激反应，但舒芬太尼全麻诱导较瑞芬太尼具有更稳定的血流动力学。
Objective to compare the effect of sulfentanyl and remifentanil by target controlled infusion on tress reaction to tracheal intubation in older patients Mthods Forty patients age 65 - 75 undergoing selective operation with total intravenous anaesthesia were divided 2 groups at random ： R group and S group Using step -by -step target- controlled infusion （TCI）, bispectral index（BIS） was controlled under 60 by giving propofol . SBP, DBP, HR and BIS of all patients were recorded at entering operating room（T0 ） , the instant before tracheal intubation （ T1 ） and after tracheal i ntubation （ T2 ） , at 1 min （ T3 ） ,3 min （ T4 ）, 5 min （ T5 ） and 10 min （ T6 ） after tracheal intubation . The concentrations of cortisol were measured at T0,T3, T 5 - T6. Results SBP, DBP, HR, BIS and the concertration of cortisol had no significant difference between R group and S group as whole . compared with TO , SBP and DBP decreased after tracheal intubation in two groups （ P 〈 0.05 ） . compared with To, the concentrateion of cortisol increased first and then declined after tracheal intubation in two group（P 〈 0.05 ） It showed a significant interactive effect in SBP. SBP at T5 and T4 decreased to that at T1 in R group and S group , espectinely. Conclusion ： Remifintayl and sulfantanyl through TCI could restrain stress reaction induced by tracheal intubation in older patients , but sulfantanyl could restrain fluctuation of blood pressure induced by tracheal intubation better than remifentanyl the balance of circulateon system.
关键词
舒芬太尼
瑞芬太尼
靶控输注
全麻诱导期
老年患者
Remifentamil
Sulfantamyl
Target - controlled infusion
Anesthetic induction Geriatrics
