参附注射液对老年手术患者全麻诱导期循环稳定性的影响

作者	单位
郑俊奕	广州中医药大学第一附属医院麻醉科
马武华	广州中医药大学第一附属医院麻醉科
陈鸶	广州中医药大学第一附属医院麻醉科
罗艳霞	广州中医药大学第一附属医院麻醉科
王可佳	广州中医药大学第一附属医院麻醉科

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中文摘要:

目的观察参附注射液对老年手术患者全麻诱导后血流动力学及循环功能的干预作用,进一步优化老年手术患者麻醉诱导期用药。方法选择拟行全麻的老年患者60例,随机分成参附组和对照组,每组30例。参附组于全麻诱导前用参附注射液1mL/kg稀释至6mL/kg静脉滴注,对照组予以等量生理盐水。然后实施全麻诱导和气管插管。记录两组入室时(T1)、给药后(T2)、全麻诱导前(T3)、诱导期间收缩压最低点(T4)、插管前(T5)、插管后(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR)、中心静脉压(CVP)、脉搏血氧饱和度(SpO2)、心电图ST段水平及麻醉诱导期麻黄碱和阿托品的使用剂量和使用率。结果与本组T1比较,参附组T2、T3及T6时间点时CVP升高(P<0.05),T4、T5及T6时间点时SBP、DBP降低、HR升高(P<0.01);对照组T2、T3及T6时间点时CVP升高(P<0.05),HR差异有统计学意义(P<0.05),T4、T5及T6时间点时SBP、DBP降低、HR升高(P<0.01)。组间比较:T2时间点CVP两组比较差异有统计学意义(P<0.05);T4、T5及T6时间点SBP、DBP及HR两组比较差异均有统计学意义(P<0.05,P<0.01)。结论参附注射液用于老年人全麻诱导过程中能明显减少血流动力学的波动程度,防止此期间心肌缺血的发生,且对心肌缺血具有明确的治疗作用。

英文摘要:

Objective To observe the intervention of Shenfu Injection (SFI) on the hemodynamics and circulatory function during induction of general anesthesia for aged people,in order to optimize the medication of anesthesia inductive phase in aged people. Methods Sixty aged patients scheduled to receive general anesthesia were equally randomized into 2 groups,the SFI group and the control group. SFI via intravenous drip (1 mL/kg diluted with 5 mL/kg saline) was administered to the SFI group 15 min before anesthesia induction and to the control group,normal saline was administered instead. Then the induction and intubation were implemented. The systolic blood pressure (SBP),diastolic pressure (DBP),heart rate (HR),central venous pressure (CVP),pulse saturation oxygen (SpO2),and the ST segment of ECG were observed at the different time points of induction,i.e. at the time of entry into the operating room (T1),ending the medication (T2),before the induction (T3),showing the lowest SBP in induction (T4),before and after intubation (T5 and T6). The dose and frequency of atropine and ephedrine applied in the inductive phase were observed as well. Results As compared with the baseline values measured at T1,CVP elevated at T2,T3,and T6 (P<0.05),SBP and DBP descended at T4,T5,T6 in both groups;HR accelerated at T2 T3,and T6 in the control group;and HR at T4,T5 and T6 in both groups were significantly different (P<0.05 or P<0.01). Inter-group comparisons showed significant difference between groups in CVP at T2 (P<0.05);so did SBP,DBP and HR at T4,T5 and T6 (P<0.05 or P<0.01). Conclusion Application of SFI in the inductive phase of general anesthesia in aged people could evidently reduce the fluctuation of hemodynamics to prevent the occurrence of myocardial ischemia and improve it definitely.

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