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小剂量肾上腺素和麻黄碱对老年患者顺式阿曲库铵起效时间及血流动力学的影响
Effects of low doses of epinephrine and ephedrine on the onset time of cisatracurium and the hemodynamic during the induction of anesthesia in elderly patients

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DOI:
作者:
陈长宝,王爱忠，江伟
CHEN Chang-bao,WANG Ai-zhong,JIANG Wei
作者单位:
苏州大学，上海市第六人民医院麻醉科，上海市第六人民医院麻醉科
Soochow University;Department of Anesthesiology,Shanghai Sixth People's Hospital;Department of Anesthesiology,Shanghai Sixth People's Hospital
关键词:
肾上腺素；麻黄碱；顺式阿曲库铵；起效时间；血流动力学
Epinephrine;Ephedrine;Cisatracurium;Onset time;Hemodynamic
摘要:
目的：观察小剂量肾上腺素和麻黄碱对老年患者全麻诱导期顺式阿曲库铵起效时间和血流动力学的影响。方法：75例择期在全麻下行膝关节或髋关节置换术老年患者，随机分为三组，肾上腺素组(Ep组)、麻黄碱组(E组)和生理盐水组(S组)，每组25例。各组在芬太尼和丙泊酚诱导后，分别给予肾上腺素0.06 ug/kg、麻黄碱70 ug/kg或生理盐水5 ml，然后静注顺式阿曲库铵0.15 mg/kg。记录肌松起效时间及气管插管评级。监测心排量、有创桡动脉压、心率变化。结果：Ep组和E组的肌松起效时间都显著短于S组（P<0.05），Ep组和E组的气管插管评级也显著优于S组（P<0.05）。诱导后Ep组和E组的心排量显著高于S组，Ep组与E组低血压发生率远低于S组（P<0.01），而插管后高血压的发生率E组明显高于Ep组和S组（P<0.05），Ep组和S组比较差异无统计学意义。结论：0.06 ug/kg肾上腺素和70 ug/kg麻黄碱都可缓解老年患者全麻诱导时的循环抑制，缩短顺式阿曲库铵的起效时间，改善插管条件。肾上腺素作用短暂，不会加剧气管插管所致的高血压，因而更适合老年患者。
Objective To evaluate the effects of low doses of epinephrine and ephedrine on the onset of cisatracurium and the hemodynamic during the induction of anesthesia in elderly patients.Methods 75 elderly patients undergoing knee or hip replacement under general anesthesia were randomly assigned to three groups (n=25).The induction of anesthesia consisted of 3 ug/kg of fentanyl,2.5 mg/kg of propofol,Patients were randomly assigned to receive either 0.06 ug/kg of epinephrine（group Ep）、70 ug/kg of ephedrine (group E) or saline placebo (group S),and then 0.15mg/kg of cisatracurium was administrated.The onset time of cisatracurium and the intubation condition were measured. The cardiac output,the invasive blood pressure,the heart rate were also measured continuously.Results The onset time of cisatracurium in group Ep and E were significantly shorter than that in group S（P<0.05）.The intubation conditions in group Ep and E were significantly better than grouop S（P<0.05）.The cardiac output was significantly higher in group Ep and E after induction.The probability of hypotension was significantly lower in group Ep and E than group S（P<0.01）.The probability of hypertension was significantly higher in group E than group Ep and S（P<0.05）.Conclusion Both 0.06 ug/kg of epinephrine and 70 ug/kg of ephedrine can alleviate circulatory depression and accelerate the onset time of cisatracurium and improve intubating conditions during induction of general anesthesia in elderly patients.The epinephrine is much more suitable for the elderly patients due to the short duration and less change to aggravate post intubation hypertension.

 

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