摘要
目的 比较两组雷米芬太尼对行下肢关节置换术的老年患者应激反应的影响,以优化雷米芬太尼在老年患者中的使用剂量。方法 40例患者,麻醉风险评分为Ⅱ～Ⅲ级,年龄65～75岁。随机将患者分为两组：0.5μg/（kg·min）（L组）和1～μg/（kg·min）（G组）,每组20例。分别记录在插管前（T_1）、插管后5 min（T_2）、切皮后5 min（T_3）、拔管后5 min（T_4）、术后30 min（T_5）的血压、心率及相应时间的肾上腺素及血糖浓度。记录还包括拔管时间、镇静评分（OAA/S）。结果 两组在年龄、体重、手术时间、拔管时间、恢复室的镇静评分上差异均无统计学意义。L组与G组T_4与T_1的心率、平均动脉压在组内比较差异有统计学意义（P〈0.05）,组间比较差异无统计学意义;L组血糖浓度T_3、T_5与T_1比较差异有统计学意义（P〈0.05）。其他时间点各指标组内与组间比较差异均无统计学意义。L组和G组的血糖浓度呈逐渐升高趋势,但在正常值范围内。两组的肾上腺素在各时间点组内与组间比较差异均无统计学意义。两组的丙泊酚和去氧肾上腺素的使用量差异有统计学意义。结论 两组雷米芬太尼都可以抑制手术刺激所引起的应激反应。0.5μg/（kg·min）的雷米芬太尼维持量对于进行下肢关节置换术的老年患者更有利。
Objective To compare the stress reactions in the old patients undergoing lower limbs replacement surgery in two groups treated with different doses of remifentanil, so as to optimize the dosage of remifentanil for the elderly. Methods Forty ASAⅡ - Ⅲ patients aged 65 -75yr being scheduled for lower limbs replacement surgery were randomly divided into two groups （ n = 20 each ） ：0.5 μg/（ kg ·min ） （ L group ） and 1.0μg/（kg · min ） （ G group ）. MAP, HR, glucose and adrenalin were recorded at the points of time as before intubation （ T1 ）, 5min after intubation （ T2 ） , 5 min after skin incision （ T3 ） , 5 min after extubation （ T4 ） and 30 min after operation （ T5 ）. And also recorded were extubation time and OOA/S. Results The weight, operation time , extubation time did not show statistical difference between the two groups. MAPs and HRs at T4 and T1 compared were of statistical difference within each group （ P 〈 0.05 ） , but not between the two groups . The glucose values at T5 , T3 and T1 compared were of statistically significant difference in L group. The glucose values in L group and G group elevated gradually, but were in normal range. Adrenalin did not show significant difference in variation at the different points of time within each group or between the two groups. Statistically significant differences were shown in different doses of propofol and noradrenalin used in the two groups. Conclusion Remifentanil used in both groups proved to be able to attenuate stress reaction, and 0.5 μg/（ kg · min） was the optimum dosage of remifentanil in the elderly undergoing lower limbs replacement surgery.
出处
《上海预防医学》
CAS
2016年第2期109-112,共4页
Shanghai Journal of Preventive Medicine
关键词
雷米芬太尼
老年
血糖
应激反应
remifentanil
elderly
adrenalin
glucose
sress
