文章摘要
不同剂量去甲肾上腺素对高龄患者全麻诱导后血流动力学的影响
Effect of different doses of norepinephrine on hemodynamics in elderly patients after anesthesia induction
投稿时间：2020-08-02  
DOI：10.3969/j.issn.1000-0399.2021.01.005
中文关键词: 去甲肾上腺素  麻醉诱导  血压  心率
英文关键词: Norepinephrine  Anesthesia induction  Blood pressure  Heart rate
基金项目:重庆市自然科学基金（项目编号：cstc2019jcyj-msxmx0623）
作者单位E-mail
沈茜 400030 重庆 重庆大学附属肿瘤医院麻醉科  
唐家喜 400030 重庆 重庆大学附属肿瘤医院麻醉科  
倪娜 400030 重庆 重庆大学附属肿瘤医院麻醉科  
蒋聪 400030 重庆 重庆大学附属肿瘤医院麻醉科  
熊章荣 400030 重庆 重庆大学附属肿瘤医院麻醉科 cqxzr0118@163.com 
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中文摘要:
      目的 观察静脉泵注不同剂量去甲肾上腺素对高龄患者全麻诱导后血流动力学的影响，探讨该药有效性和适宜剂量。方法 选取2018年8月至2020年2月在重庆大学附属肿瘤医院行全身麻醉的择期手术患者160例（年龄 ≥ 75岁）为研究对象，采用随机数字表法分为4组：A组（对照组）、B组[去甲肾上腺素0.025 μg/（kg·；min）]、C组[去甲肾上腺素0.050 μg/（kg·；min）]与D组[去甲肾上腺素0.075 μg/（kg·；min）]，每组40例。B组、C组、D组于麻醉诱导开始时刻分别以0.025 μg/（kg·；min）、0.050 μg/（kg·；min）、0.075 μg/（kg·；min）速度静脉泵注去甲肾上腺素至切皮。A组于同期以同等速度静脉泵注生理盐水。4组分别于麻醉诱导前（T0）、气管插管前（T1）和气管插管即刻（T2），以及气管插管后1（T3）、3（T4）、5（T5）、10分钟（T6）和切皮即刻（T7），记录各时点血流动力学变化及心脏不良事件发生率，主要指标：全麻诱导后至切皮低血压的发生率；次要指标：全麻诱导后至切皮高血压和心动过缓的发生率。结果 4组患者不同时点收缩压（SBP）和舒张压（DBP）有随时间及分组的变化趋势，4组患者存在时间、组间及交互效应（P<0.05），与A组比较，C组、D组SBP和DBP在T1-T7时点明显升高，差异有统计学意义（P<0.05）。4组患者不同时间点心率（HR）有随时间的变化趋势，4组患者存在时间效应（P<0.05），无组间及交互效应（P>0.05），与A组比较，B组、C组、D组HR在T1-T7时点无明显变化，差异无统计学意义（P>0.05）。C组、D组低血压发生率明显低于A组，差异有统计学意义（P<0.007 1）。4组患者高血压发生率、心动过缓发生率差异无统计学意义（P>0.05）。结论 持续静脉泵注去甲肾上腺素0.050 μg/（kg·；min）和0.075 μg/（kg·；min）对于预防高龄患者麻醉诱导后低血压是安全有效的。
英文摘要:
      Objective To observe the effects of intravenous infusion with different doses of norepinephrine on hemodynamic changes in elderly patients after anesthesia induction, so as to explore the effectiveness and appropriate dosage. Methods We included 160 selective operation patients aged 75 and older who underwent general anaesthesia from August 2018 to February 2020 in Chongqing University Cancer Hospital. Patients were randomly divided into four groups (n=40). In control group, patients received saline infusion, while in three norepinephrine groups, the infusion rate was 0.025, 0.050, and 0.075 μg/(kg·min) respectively. Hemodynamic changes and the incidence of cardiac adverse events were recorded before anesthesia induction (T0), before intubation (T1), immediately after intubation (T2), 1 min (T3), 3 min (T4), 5 min (T5), 10 min (T6) after intubation, and immediately in skin incision (T7). The primary outcome was the frequency of hypotension. The Secondary outcome was the frequency of hypertension and bradycardia. Results The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of patients in four groups showed a tendency to change with time and group at different time points, and the time effect, group effect and interaction effect all existed (P<0.05). SBP and DBP significantly increased in group C and group D than in group A at the time T1-T7, and the difference was statistically significant (P<0.05). The heart rate (HR) of patients in four groups showed a trend of changing with time at different time points, and the time effect existed (P<0.05), while there was no group effect nor interaction effect (P>0.05). Compared with group A, HR had no significant change in group B, group C and group D at time T1-T7, and the difference was not statistically significant (P>0.05). The incidence of hypotension was significantly lower in group C and group D than in group A, and the difference was statistically significant (P<0.007 1). The incidence of hypertension and bradycardia presented no statistically significant difference among the four groups (P>0.05). Conclusions The infusion rates of norepinephrine at 0.050 and 0.075 μg/(kg·min) are safe and effective in preventing hypotension after anesthesia induction in elderly patients.
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