【作者】 刘伟；

【导师】 王天元；

【作者基本信息】 吉林大学 ， 麻醉学， 2005， 硕士

【摘要】 随着老年人口数目的增长,老年人的麻醉成为一个日益受到重视的问题。老年人由于年龄增长而致的周身器官功能的减退和组织细胞的退行性改变,生理病理的改变常导致麻醉用药的药代动力学和药效动力学的变化, 导致其对麻醉和手术的耐受力较差,因此怎样既保证麻醉质量和麻醉安全,又对患者的生理机能干扰最小,麻醉药物及方法的选择、术中、术后维持平稳的血流动力学及麻醉作用的迅速消除对老年人的生命安全和术后的及早康复都起着不可忽视的作用。我们选择40 例老年病人随机分成2 组,一组采用异氟醚持续吸入维持麻醉,一组采用脑电双频谱分析指数(BIS)反馈的丙泊酚靶控输注(TCI)全凭静脉麻醉。记录术前,术中共7 个时点的血流动力学及BIS 值的改变,以及术后苏醒、拔管时间,术后并发症,并对结果进行统计学分析。结果提示:BIS反馈的丙泊酚靶控输注的麻醉方法对维持老年人术中的血流动力学的稳定优于异氟醚的持续吸入,且在苏醒时间无差别的前提下其苏醒质量优于异氟醚的持续吸入,术后的并发症也少于异氟醚的的持续吸入。更多还原

【Abstract】 With the number of aged increasing, more and more people pay attention to the problem of the aged anesthesia. The aged often change in pharmacokinetics and pharmacodynamics due to declining of the organic function recessive and pathophysiology change of histiocyte. The aged can easier suffer from cardiovascular accident, such as heart failure, myocardial infarction serious arrhythmia and so on. Which make then worse resistance to the anesthesia and operations. How to ensure the quality and safety or anesthesia or minimize the physiological disturbance of the patients? Maintained hemodynamic stable in per-operation and post-operation, rapidly eliminating the function of anesthesia are used to the old patients’safety and early recovering. Propofol is the most popular drug of nonbarbiturates, it has been widely apply to clinic because of several merits, such as fast-effect, higher ratio of plasm elimination, coming to the patients themselves quickly and completely, without mental symptom, scarcely nausea and vomit and not acute endurance. With stronger function of cardiac restainer and vassal dilatation, propofol can lead to the dropping of blood pressure in induction of anesthesia, especially the aged and the patients with hyertersion , but the individual diversity is obvious. TCI, the integration of research on pharmacokinetics and computer technology, is a important transformation of the method on vein anesthesia. The analysis of bispectral index is the first method to measure the affection of drug hypnogenesis, authorized by American FDA. Recursive equation of bispectral index can refect to 0～100, narnly BIS value, BIS value can refect the state of consciousness perfectly. Many research show that when BIS﹤55, the patients can avoid the consciousness in perioperation. When we apply to propofol of TCI by the way of BIS value, we can find the depth of anesthesia it representing has a very approprivate correlation on the dosage and plasma concentration of propofol. Tradional anesthesia effects the hemodynamic of the aged seriously. Therefore, the aim of the article is to observe the clinicaffection of the aged with propofol TCI feedbacked by BIS value. Forty patients are ASA I ～II,who were to undergo elective operation of gastric cancer or rectum cancer , the time of operation is between 1.5～2.5hours,and their ages are between 65～80 years, their weights are between 50～80Kg.They have normal function of heart, lung, liver, kidney .They don’t have central nervous system and endocrine system’s disease and don’t have hypertension. The patients were divided into two groups in random: the group of target controlled infusion of propofol for TIVA(T group, n=20) and the group of isofurane anesthesia(n=20). The difference of patients’ages, sexes, weight are not statistically significant between two groups. All patients received pre-medication with atropine 0.5mg im. T group adoped target controlled infusion of propofol for TIVA with the TCI-I pump, it is produced with the Beijing silugao high-tech development corporation. Induction of anesthesia with Propoful target concentration was 3.0μg/ml, Midazolam5mg, Fentanyl 2.0μg/kg, Nocuron 0.08mg/kg, then tracheal intubation. Maintenance of anesthesia with Propoful target concentration 2～3μg/ml, depended on BIS (bispectral index) adjustment, it’s measurement with HDX-I type multifunctional wardship apparatus from Heilongjiang Huaxiang company. The feedback target is BIS=50±5. At the same time infusion norciun if the operation needed, stop target infusion before 10 minutes at the time of the operation ended. I group adopde vein complex induction , propoful 1.5mg/kg iv, the others were same with before. Then tracheal intubation, adjusted the inhaled concentration of isoflurane 0.5%～2.0% to maintenance anesthesia, until 10 minutes before the end of operation. Because all operation wasted 1.5～2.5 hours , fentanyl’s elimination half-time is 4.2h, fentanyl wasn’t superaddition in the operation. Two groups didn’t use antagonism. Inspected and memorized the followings: SBP、DBP、HR、BIS were monitored at time of entered the operating room(T1), induction(T2), tracheal intubation ( T3 ) , exploration(T4), 30minutes afterinduction(T5), 60minutes after induction(T6), extubation (T7). Noted the recovery times(ended operation to revival), the extubation times(ended operation to extubation),and the condition of revival. The results were expressed with “( x ±s)”, statistic analysis was performed with T test to examine intergroup differences. The P ﹤0.05 was considered statistically significant. Results All the patients in these groups have no difference in basic information. All the patients’blood pressure and rate of heart were declined, but all were in the safe range. Under the intensive stimulation, the group of isoflurane is hyperirritability, during the anesthesia of propofol TCI the hemodynamics is more stable than of isoflurane inhalation. The recovery times and extubation times of two groups have no difference, but the propofol group recovery was better than isoflurane group. Conclusion: monitoring the hemodynamics during the course anesthesia and visiting the patients after operation, so the anesthesia maintained with target controlled infusion by feedback from BIS for更多还原