【作者】 陈勇柱；

【导师】 苏子敏； 仓静； 葛圣金；

【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气雾剂对老年病人七氟烷吸入诱导的影响。方法:本实验为前瞻性随机双盲临床实验。研究方案通过复旦大学附属中山医院伦理委员会审议后,随机选择30名ASAⅠ-Ⅱ级的65～75岁的病人。请独立的第三方将沙丁胺醇气雾剂及空白对照剂各15支标识后混合随机编号。麻醉诱导前30 min,将己编号的气雾剂随机给予入选病人。8 L/min新鲜氧流量、6%七氟烷预冲回路2 min后,病人自主呼吸完成5.5 min的吸入诱导过程。在诱导过程中,记录如下数据:心率（HR）,有创动脉血压（IBP）,脉搏氧饱和度（SpO₂）,吸入气七氟烷浓度（InSEV%）,呼气末七氟烷浓度（EtSEV%）,脑电双频指数（BIS）,意识丧失时间（LOC）,以及呼吸暂停（＞20 s）、咳嗽、兴奋、躁动、喉痉挛等情况。同时分别于130 s和250 s抽取动脉血样来检测血样中七氟烷浓度。实验完成后揭盲,应用软件SPSS11.5（SPSS,Chicago,IL）统计分析诱导过程中各项观测指标的变化来研究沙丁胺醇气雾剂对老年病人七氟烷吸入诱导的影响。结果:诱导开始后,EtSEV%随时间逐步上升,InSEV%初略降后基本稳定,BIS随时间逐步下降,HR、MAP初均基本稳定中段上升后明显下降。BIS快速下降发生在60～120 s之间,实验组LOC为76±12 s,对照组为75±13 s,组间无统计学差异,P＞0.05。130 s时实验组动脉血七氟烷浓度和EtSEV%分别为63.2±18.7 ppm、3.45±0.89,对照组为54.0±16.8 ppm、3.60±0.33,组间无统计学差异,P＞0.05。250 s时实验组动脉血七氟烷浓度和EtSEV%分别为75.4±16.1 ppm、4.14±0.36,对照组为74.0±26.9 ppm、4.06±0.31,组间无统计学差异,P＞0.05。330 s诱导结束时,实验组EtSEV%和BIS分别为4.33±0.31、35±8,对照组为4.25±0.31、36±7,组间无统计学差异,P＞0.05。BIS在240s时有统计学差异,P＜0.05。结论:沙丁胺醇气雾剂对可能老年病人七氟烷吸入诱导无影响。更多还原

【Abstract】 PurposeTo study the effect of salbutamol aerosol on sevoflurane induction in elderly patients.MehtodsAfter obtaining Ethics Committee approval,30 patients,aged 65-75-yr-old,ASA gradeⅠ-Ⅱundergoing elective surery with general anaesthesia randomly entered the study.The Patents allocated randomly by closed envelope technique to one of two groups and each group was 15 patents.One group was given the salbutamol aerosol 30 minutes before the induction and the other was black.The patients were induced by 8L/min fresh flow O₂ and 6%sevoflurane with patient controlled inhalation induction.During the induction,we recorded the data:heart rate（HR）,invasive blood pressure（IBP）,pulse oxygen saturation（SPO₂）,inspiratory sevoflurane concentration（InSEV%）,end-tidal sevoflurane concentration（EtSEV%）, bispectral index（BIS）,loss of consciousness（LOC）,apnoea（＞20s）,movements, laryngospasm and coughing.Meanwhile,we draw the arterial blood samples to analysis the concentration of sevoflurane in arterial blood.ResultsWhen the induction begin,EtSEV%grown up step by step,InSEV%first dropped and then keep stability,BIS dropped step by step,HR、MAP first keep stability and grown up in the middle and at last significantly dropped.LOC in the experimental group was 76±12 s and in the placebo group was 75±13 s,P＞0.05.The concentration of sevoflurane in arterial blood and EtSEV%at 130 s in the experimental group were 63.2±18.7 ppm、3.45±0.89,in the placebo group were 54.0±16.8 ppm、3.60±0.33,P＞0.05.The concentration of sevoflurane in arterial blood and EtSEV%at 250 s in the experimental group were 75.4±16.1 ppm、4.14±0.36,in the placebo group were 74.0±26.9 ppm、4.06±0.31,P＞0.05.The end at 330 s,EtSEV% and BIS in the experimental group were 4.33±0.31、35±8,in the placebo group were 4.25±0.31、36±7,P＞0.05.The BIS at 240s was significantly different between the two groups,the experimental group was 38±9,the placebo group was 48±14,P＜0.05.ConclusionsSalbutamol aerosol has no effect on sevoflurane induction in elderly patients.更多还原