【摘要】 目的用FloTrac/Vigileo系统评估七氟烷和丙泊酚诱导对老年患者血流动力学的影响。方法择期行胃肠道肿瘤手术老年患者40例,年龄60～75岁,美国麻醉医师协会(ASA)Ⅱ级。随机分为两组(n=20):七氟烷诱导组(S组)与丙泊酚诱导组(P组)。S组采用8%七氟烷预充呼吸回路快速诱导法,P组设定丙泊酚血浆靶控(TCI)浓度3μg/ml行麻醉诱导。记录基础值(T0)、脑电双频指数(BIS)降为60时(T1)、插管前即刻(T2)、插管后即刻(T3)、插管后1,3,5,10,15和20 min(T4～9)的平均动脉压(MAP)、心率(HR)、心排量(CO)、每搏量(SV)以及机械通气后各时点的每搏量变异度(SVV)。结果 CO:两组在插管前即刻降至最低水平,S组降低幅度大于P组(P<0.05)。SV:P组降低幅度大于S组,S组插管后5 min、P组插管后10 min趋于稳定(P<0.05)。MAP:S组插管后5 min、P组插管后10 min趋于平稳,P组降低幅度大于S组(P<0.05)。HR:S组插管前即刻较基础值降低12.1%,P组插管后1 min高于基础值7.5%(P<0.05)。P组SVV试验中各时点均高于S组(P<0.05)。结论在诱导开始至插管前阶段,七氟烷诱导对心排量的影响程度较大。插管后20 min的维持阶段,七氟烷组各指标趋于稳定所需时间明显短于丙泊酚组。更多还原

【Abstract】 ObjectiveTo compare the effect of sevoflurane and propofol in anesthesia induction on the cardiac output(CO) and stroke volume(SV) among elders with digestive system surgical procedures,estimated by hemodynamic indexes from FloTrac/Vigileo device.Accordingly,in order to provide references for the choice of the optimal anesthesia induction method.MethodsForty ASA(American Society of Anesthesiologists) Ⅱ patients aged 60 to 75 years and undergoing elective digestive system surgical procedures were randomly divided into two groups: sevoflurane(S) group(Ⅰ)and propofol(P) group(Ⅱ).In group S,tachy-induced anesthesia was facilitated with 8% sevoflurane inhalation while group P was induced with propofol(by target control injection,TCI) 3 μg/ml.BIS was maintained at 50-45 through sevoflurane inhalation and propol TCI concentration regulated 20 min after induction.The mean arterial pressure(MAP),heart rate(HR),and SV were routinely monitored.Stroke volume variation(SVV) was monitored soon after anesthesia induction by Flotrac/Vigileo device.All indexes were recorded before anesthesia(T0),BIS down to 60(T1),before intubation(T2),after intubation(T3),1 min,3 min,5min,10 min,15 min and 20 min after intubation(T4-9).ResultsCO: Compared with the base value,CO fell to the lowest level before intubation.CO was decreased greatly in group S(P<0.05).SV: Compared with the base value,SV was decreased greatly in group P(P<0.05) but soon turned to a stable level 5 min after intubation in group S and at 10 min in group P.MAP: Compared with the base value,MAP was decreased in the two groups after intubation.It was significantly recovered at 1 min after intubation in group S,and then decreased again in the two groups.It turned to a stable level at 5 min after intubation in group S and 10 min in group P.It was decreased greatly in group P(P<0.05).HR:Compared with the base value,HR was slowed after induction in the two groups,decreased by 12.1% in group S before intubation.It was increased by 7.5% at 1 min after intubation but turned to stable level at 5 min after intubation in the two groups.Compared to group P,HR was decreased greatly in group S(P<0.05).SVV remained higher in group P.ConclusionFrom induction of anesthesia to intubation of digestive system surgical procedures on elderly patients,sevoflurane represses circulation more effectively than propofol.During maintenance anesthesia,20 min after intubation,CO,SV,and MAP are all decreased in the two groups,but it takes sevofurane less time to return to normal than propofol.更多还原