【作者】 陈佳莉；

【导师】 仓静； 庄小凤； 葛圣金； 苏子敏；

【作者基本信息】 复旦大学 ， 麻醉学， 2008， 硕士

【摘要】 目的:研究β₂受体激动剂沙丁胺醇对老年患者七氟醚摄取的影响。方法:采用前瞻性随机双盲临床试验。将15支沙丁胺醇试剂和15支空白对照试剂按随机数字编号。选择ASAⅠ～Ⅱ级,年龄65～75岁,BMI 18～30 kg/m²,拟在全身麻醉下行择期手术的老年患者30例,术前签署知情同意书。入手术室后常规监护,开放静脉,桡动脉置管监测有创血压,按试剂编号口腔喷雾给药200μg（2揿）。30 min后行全麻诱导,静脉推注芬太尼3μg/kg,丙泊酚2 mg/kg,爱可松0.9 mg/kg,气管插管后控制通气,开启七氟醚挥发罐浓度为2%,氧流量2 L/min,调节潮气量8～10 ml/kg,呼吸频率10 bpm,吸呼比1:2,维持EtCO₂于30～35 mmHg。记录插管后1、2、3、5、10、15 min的心率（HR）、有创血压（IBP）、脉搏氧饱和度（SpO₂）、呼气末CO₂分压（EtCO₂）、吸入七氟醚浓度（Insevo）%和呼气末七氟醚浓度（Etsevo）%。全部实验完成后揭盲,统计分析沙丁胺醇组和空白对照组的七氟醚吸入浓度（Fi）、肺泡浓度（Fa）、Fa/Fi及患者HR、平均动脉压（MAP）的变化。结果:两组身高、年龄、体重、BMI、基础HR、基础MAP均不具有统计学显著差别（P＞0.05）。沙丁胺醇组和空白对照组在插管后1、2、3、5、10、15 min时七氟醚吸入浓度（Fi,即Insevo）分别为0.71±0.11、0.95±0.10、1.12±0.13、1.36±0.11、1.62±0.09、1.71±0.07和0.61±0.14、0.93±0.12、1.10±0.11、1.34±0.14、1.61±0.13、1.74±0.09。组内比较Fi有统计学显著差别（P＜0.05）,显示七氟醚的吸入浓度随时间逐渐增加,组间比较两组插管后1 min的Fi有统计学显著差别（P＜0.05）,插管后2、3、5、10、15 min的Fi均无统计学显著差别（P＞0.05）。沙丁胺醇组和空白对照组在插管后1、2、3、5、10、15 min时七氟醚肺泡浓度（Fa,即Etsevo）分别为0.35±0.10、0.58±0.07、0.71±0.09、0.93±0.11、1.20±0.08、1.36±0.10和0.29±0.11、0.55±0.07、0.70±0.10、0.93±0.11、1.23±0.12、1.39±0.08。组内比较Fa有统计学显著差别（P＜0.05）,显示七氟醚的肺泡浓度随时间逐渐增加,组间比较两组在各时点的Fa均无统计学显著差别（P＞0.05）。沙丁胺醇组和空白对照组组内比较显示HR在气管插管后1分钟上升,第2、3分钟下降（P＜0.05）,10分钟后趋于平稳（P＞0.05）,MAP在气管插管后5分钟内呈下降趋势（P＜0.05）,10分钟后趋于平稳（P＞0.05）。两组间比较插管后1、2、3、5、10、15 min的HR、MAP无统计学显著差别（P＞0.05）。结论:β₂受体激动剂沙丁胺醇对老年患者七氟醚的摄取可能没有影响。更多还原

【Abstract】 Objective:To study whetherβ₂ agonist salbutamol has an effect on the uptake of sevoflurane in elderly patients.Methods:It is a prospective randomized double-blind study.With Ethical Committee approval and written informed consent,30 patients aged 65～75 years,ASAⅠ～Ⅱ, BMI 18～30 kg/m²,undergoing general anesthesia were randomly received either salbutamol（n=15） or control sample（n=15） 200μg per-person.General anesthesia was induced with fentanil 3μg/kg,propofol 2mg/kg and rocuronium 0.9 mg/kg 30 min later.When the trachea was intubated,Intermittent positive pressure ventilation（IPPV） was applied with 2%sevoflurane and a 2 L/min fresh gas flow（tidal volume:of 8～10 ml/kg;respiratory rate:10 breaths/min;inspiratory to expiratory time ratio of 1:2; to maintain EtCO₂ 30～35mmHg）via a nonrebreathing circuit.HR,IBP,S_PO₂,EtCO₂, Insevo and Etsevo were recorded 1,2,3,5,10,15 min after intubation.We expose the two groups after the whole trial,and get the conclusion whether there is a different speed on the uptake of sevoflurane between the two groups.Results:There is no statistical difference in height,age,weight,BMI,base HR and base MAP between the salbutamol group and the control group（P＞0.05）.The inhaled concentration of sevoflurane（Fi） at 1,2,3,5,10,15 min of the salbutamol group and the control group are 0.71±0.11,0.95±0.10,1.12±0.13,1.36±0.11, 1.62±0.09,1.71±0.07 and 0.61±0.14,0.93±0.12,1.10±0.11,1.34±0.14,1.61±0.13, 1.74±0.09 respectively.There is significant statistical difference for Fi within each group（P＜0.05）;with the increase of Fi by time,the result is different:there is significant statistical difference for Fi between the salbutamol group and the control group at 1 min after intubation（P＜0.05）,but there is no significant statistical difference for Fi between the groups at 2,3,5,10,15 min after intubation（P＞0.05）. The concentration of sevoflurane in pulmonary alveoli（Fa） on 1,2,3,5,10,15 min of the salbutamol group and the control group are 0.35±0.10,0.58±0.07,0.71±0.09, 0.93±0.11,1.20±0.08,1.36±0.10 and 0.29±0.11,0.55±0.07,0.70±0.10,0.93±0.11, 1.23±0.12,1.39±0.08 respectively.There is significant statistical difference for Fa within each group（P＜0.05）;however,with the increase of Fa by time,there is no significant statistical difference for Fa between the groups at each time after intubation（P＞0.05）.The statistics of the salbutamol group and the control group shows that,within each group,HR increases within 1 min after intubation,decreases within 2 min and 3 min（P＜0.05） and becomes stable after 10 min（P＞0.05）;MAP decreases within 5 min after intubation（P＜0.05） and becomes stable after 10 min（P＞0.05）.There is no significant statistical difference for HR and MAP between the salbutamol group and the control group at 1,2,3,5,10,15 min after intubation（P＞0.05）.Conclusion:β₂ agonist salbutamol may not have effect on the uptake of sevoflurane by the elderly patients.更多还原