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| 不同剂量阿芬太尼对老年患者快速顺序诱导气管插管心血管反应的影响 |
| Effects of different doses of alfentanil on cardiovascular response to rapid sequential induction of tracheal intubation in elderly patients |
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| DOI：10.12089/jca.2023.10.003 |
| 中文关键词: 阿芬太尼 快速顺序诱导 气管插管 老年 |
| 英文关键词: Alfentanil Rapid sequence induction Intratracheal intubation Aged |
| 基金项目:宜昌市医疗卫生科研项目（A22-2-041） |
| 作者 | 单位 | E-mail | | 陈小波 | 443000,三峡大学第一临床医学院,宜昌市中心人民医院麻醉科,三峡大学老年麻醉医学研究所 | | | 易雪 | 443000,三峡大学第一临床医学院,宜昌市中心人民医院麻醉科,三峡大学老年麻醉医学研究所 | | | 韩梅 | 443000,三峡大学第一临床医学院,宜昌市中心人民医院麻醉科,三峡大学老年麻醉医学研究所 | | | 舒爱华 | 443000,三峡大学第一临床医学院,宜昌市中心人民医院麻醉科,三峡大学老年麻醉医学研究所 | | | 程传喜 | 443000,三峡大学第一临床医学院,宜昌市中心人民医院麻醉科,三峡大学老年麻醉医学研究所 | chuanxi1991@163.com |
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| 中文摘要: |
目的 比较不同剂量阿芬太尼对老年患者快速顺序诱导气管插管心血管反应的影响。
方法 选择2022年3—9月行气管插管全麻老年患者96例，男47例，女49例，年龄65～80岁，BMI 18～24 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为四组：阿芬太尼10 μg/kg组（A组）、阿芬太尼15 μg/kg组（B组）、阿芬太尼20 μg/kg组（C组）和阿芬太尼25 μg/kg组（D组），每组24例。记录麻醉诱导前、气管插管后1、5 min的HR、MAP，同时抽取患者静脉血3 ml，检测血浆中去甲肾上腺素（NE）和皮质醇（Cor）的浓度、超声测量心脏指数（CI）、心脏射血分数（EF）。记录麻醉诱导后至气管插管后5 min高血压、低血压、心动过缓、心动过速的发生情况。
结果 与麻醉诱导前比较，A组和B组在气管插管后1、5 min HR明显增快，MAP、NE和Cor浓度明显升高，CI和EF明显降低（P＜0.05）；C组和D组气管插管后1 min HR明显增快，MAP明显升高，D组插管后5 min HR明显减慢，MAP、血浆NE和Cor浓度、CI和EF明显降低（P＜0.05）。与A组比较，C组和D组气管插管后1、5 min HR明显减慢，血浆NE和Cor浓度明显降低，气管插管后1 min CI和EF明显升高，高血压和心动过速发生率明显降低（P＜0.05）；D组插管后5 min CI和EF明显降低，低血压和心动过缓发生率明显升高（P＜0.05）。
结论 阿芬太尼20 μg/kg用于老年患者快速顺序诱导气管插管，可有效抑制插管引起的剧烈心血管反应，同时避免心血管系统的抑制，血流动力学更平稳。 |
| 英文摘要: |
Objective To compare the effects of different doses of alfentanil on cardiovascular response in elderly patients with rapid sequential induction and tracheal intubation.
Methods Ninty-six patients, 47 males and 49 females, aged 65-80 years, BMI 18-24 kg/m2, ASA physical status Ⅰ or Ⅱ, selected from March 2022 to September 2022 who underwent general anesthesia with tracheal intubation. The patients were divided into four groups by random number table: alfentanil 10 μg/kg group (group A), alfentanil 15 μg/kg group (group B), alfentanil 20 μg/kg group (group C), alfentanil 25 μg/kg group (group D), 24 patients in each group. HR, MAP, cardiac index (CI), and ejection fraction (EF) were recorded before anesthesia induction, 1 minute, and 5 minutes after endotracheal intubation, respectively. At the same time, 3 ml of venous blood was extracted from patients at three time points, respectively, and the contents of norepinephrine (NE) and cortisol (Cor) in plasma were detected. The incidence of hypertension, hypotension, bradycardia and tachycardia were recorded from induction of anesthesia to 5 minutes after intubation.
Results Compared with before anesthesia induction, HR, MAP, plasma NE and Cor concentrations in groups A and B were increased 1 minute and 5 minutes after endotracheal intubation, CI and EF values were decreased by ultrasound measurement(P < 0.05). HR and MAP in groups C and D were increased 1 minute after endotracheal intubation, while HR, MAP, concentrations of NE and Cor in plasma, CI and EF in group D were decreased 5 minutes after endotracheal intubation (P < 0.05). Compared with group A, the HR, MAP, plasma NE and Cor in groups C and D were decreased at 1 minute and 5 minutes after endotracheal intubation (P < 0.05), the CI and EF values were significantly increased 1 minute after intubation, the incidence of hypertension and tachycardia were significantly decreased in groups C and D (P < 0.05). Compared with group A, the CI and EF values were significantly decreased 5 minutes after intubation, the incidence of hypotension and bradycardia significantly increased in group D (P < 0.05).
Conclusion Alfentanil 20 μg/kg for rapid sequential induction of tracheal intubation in elderly patients, can effectively inhibit the violent cardiovascular reaction caused by intubation, and avoid the inhibition of cardiovascular system and stabilize hemodynamics. |
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