沙丁胺醇气雾剂对老年病人七氟烷吸入诱导的影响
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摘要
目的:
研究β_2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(SpO_2),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。
Purpose
To study the effect of salbutamol aerosol on sevoflurane induction in elderly patients.
Mehtods
After 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 O_2 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(SPO_2),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.
Results
When 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.
Conclusions
Salbutamol aerosol has no effect on sevoflurane induction in elderly patients.
研究β_2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(SpO_2),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。
Purpose
To study the effect of salbutamol aerosol on sevoflurane induction in elderly patients.
Mehtods
After 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 O_2 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(SPO_2),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.
Results
When 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.
Conclusions
Salbutamol aerosol has no effect on sevoflurane induction in elderly patients.
引文
[1] Doi M, Ikeda K. Airway irritation produced by volatile anaesthetics during brief inhalation.comparison of halothane, enflurane, isoflurane and sevoflurane [J] . Canadian Journal of Anaesthesia 1993; 40: 122-6.
[2] Abbott Laboratories Material Safety Data Sheet 1995 [ M ] .
[3] TerRiet MF, DeSouza GJA, Jacobs JS, Young D, Lewis MC, Herrington C, Gold MI. Which is the most pungent: isoflurane, sevoflurane or desflurane? [J] British Journal of Anaesthesia 2000; 85: 305-7.
[4] Peter K, Conzen P. Inhalational Anaesthesia[ J]. Clinical Anaesthesiology 1993; 7: 898-913.
[5] Ebert TJ, Harkin P, Muzi M. Cardiovascular responses to sevoflurane: a review
[J] .Anesthesia and Analgesia 1995; 81.S11-22.
[6] Smith I, Ding Y, White P. Comparison of induction , maintenance and recovery characteristics of sevoflurane-N2O and propofol-sevoflurane-N2O with propofol-isoflurane-N2O anaesthesia [ J] . Anesthesia and Analgesia 1992; 74: 253-9.
[7] Djaiani GN, Hall JE, Pugh S, Peaston RT. Vital Capacity inhalational induction with sevoflurane: an alternative to standard intravenous induction for patients undergoing cardiac surgery [J] . Journal of Cardiothoracic and Vascular Anesthesia 2001; 15: 169-74.
[8] Knaggs CL, Drummond GB.Randomized comparison of three methods of induction of anaesthesia with sevoflurane [ J] .Br J Anaesth.2005 Aug;95(2): 178-82.
[9] Goodwin N, Campbell AE, Hall JE, Plummer S, Harmer M.A comparison of 8% and 12% sevoflurane for inhalation induction in adults [J] .Anaesthesia.2004 Jan;59(1):15-9.
[10] Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T.A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients [J] .Can J Anaesth. 2003 Jan;50(1):26-31.
[11] Pancaro C, Giovannoni S, Toscano A, Peduto VA.Apnea during induction of anesthesia with sevoflurane is related to its mode of administration[J].Can J Anaesth. 2005 Jun-Jul;52(6):591-4.
[12] Yogendran S, Prabhu A, Hendy A, McGuire G, Imarengiaye C, Wong J, Chung F. Vital capacity and patient controlled sevoflurane inhalation result in similar induction characteristics[J].Can J Anaesth.2005 Jan;52(1):45-9.
[13]Calderón E,Torres LM,Calderón-Pla E.Comparative study of inhalation induction by vital capacity breath in adults using 6%sevoflurane with oxygen or 4.5%sevoflurane in 50%nitrous oxide[J,].Rev Esp Anestesiol Reanim.1999Aug-Sep;46(7):282-5.Spanish.
[14]Siau C,Liu EH.Nitrous oxide does not improve sevoflurane induction of anesthesia in adults[J].J Clin Anesth.2002 May;14(3):218-22.
[15]O'Shea H,Moultrie S,Drummond GB.Influence of nitrous oxide on induction of anaesthesia with sevoflurane[J].Br J Anaesth.2001 Aug;87(2):286-8.
[16]Mapleson WW.Effect of age on MAC in humans:a meta-analysis[J].Br J Anaesth.1996 Feb;76(2):179-85.
[17]Walpole R,Logan M.Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly[J].Br J Anaesth.1999 Jan;82(1):20-4.
[18]TobiasJD,Hirshman CA.Attenuation of histamine-induced airway constriction by albuterol during halothane anesthesia.Anesthesiology[J].1990 Jan;72(1):105-10.
[19]王德龙,刘长庭,张进川.吸烟对老年人肺功能的影响[J].中华老年医学杂志,1999年第3期第18卷.
[20]翁海霞,杨鹏麟,颜静,张素勤,徐定修.吸烟对老年人肺功能的影响[J].临床医学,2005年02期.
[21]Cavalcanti JV,Lopes AJ,Jansen JM,Melo PL.Using the forced oscillation technique to evaluate bronchodilator response in healthy volunteers and in asthma patients presenting a verified positive response[J].J Bras Pneumol.2006;32(2):91-8.
[22]张惠芬,李佩珍,张洪胜等.肺功能的随龄变化:55例通气功能长期随访[J].中华老年医学杂志,1994,13:93-95.
[1] Knaggs CL, Drummond GB.Randomized comparison of three methods of induction of anaesthesia with sevoflurane [J] .Br J Anaesth.2005 Aug;95(2): 178-82.
[2] Goodwin N, Campbell AE, Hall JE, Plummer S, Harmer M.A comparison of 8% and 12% sevoflurane for inhalation induction in adults [J] .Anaesthesia. 2004 Jan;59(1):15-9.
[3] Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T.A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients [J] .Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T.Can J Anaesth. 2003 Jan;50(1):26-31.
[4] Pancaro C, Giovannoni S, Toscano A, Peduto VA.Apnea during induction of anesthesia with sevoflurane is related to its mode of administration[J]. Can J Anaesth. 2005 Jun-Jul;52(6):591-4.
[5]Yogendran S, Prabhu A, Hendy A, McGuire G, Imarengiaye C, Wong J, Chung F. Vital capacity and patient controlled sevoflurane inhalation result in similar induction characteristics [J] .Can J Anaesth. 2005 Jan;52(1):45-9.
[6] Calderón E, Torres LM, Calderón-Pla E.Comparative study of inhalation induction by vital capacity breath in adults using 6% sevoflurane with oxygen or 4.5% sevoflurane in 50% nitrous oxide [J] .Rev Esp Anestesiol Reanim. 1999 Aug-SeP;46(7):282-5. Spanish.
[7] Siau C, Liu EH. Nitrous oxide does not improve sevoflurane induction of anesthesia in adults [J] J Clin Anesth. 2002 May; 14(3):218-22.
[8] O'Shea H, Moultrie S, Drummond GB.Influence of nitrous oxide on induction of anaesthesia with sevoflurane [J] .Br J Anaesth. 2001 Aug;87(2):286-8.
[9] Tomoki Nishiyama ,Takashi Matsukawa ,Takeshi Yokoyama , Kazuo Hanaoka. Rapid Inhalation Induction with 7% Sevoflurane Combined with Intravenous Midazolam [J] Journal of Clinical Anesthesia 14:290-295, 2002.
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[19]Lewis MC,TerRiet M,DeLaCruz L,Matadial CM,Gerenstein R,DeSouza G,Chidiac GJ.Rapid sevoflurane induction compared with thiopental[J].J Clin Anesth.2004 Jun;16(4):271-5.
[20]Djaiani GN,Hall J,Pugh S,Peaston RT.Vital capacity inhalation induction with sevoflurane:an alternative to standard intravenous induction for patients undergoing cardiac surgery[J].J Cardiothorac Vasc Anesth.2001 APr;15(2):169-74.
[21]Aguilera IM,Patel D,Meakin GH,Masterson J.Perioperative anxiety and postoperative behavioural disturbances in children undergoing intravenous or inhalation induction of anaesthesia[J].Paediatr Anaesth.2003 Jul;13(6):501-7.
[22]Walpole R,Logan M.Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly[J].Br J Anaesth.1999 Jan;82(1):20-4.
[23]Wakamatsu T,Hiromi R,Kato S.Anesthetic management of morbidly obese patients using inhalation induction with high concentrations of sevoflurane[J].Masui.2005 Jul;54(7):791-3.
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[2] Abbott Laboratories Material Safety Data Sheet 1995 [ M ] .
[3] TerRiet MF, DeSouza GJA, Jacobs JS, Young D, Lewis MC, Herrington C, Gold MI. Which is the most pungent: isoflurane, sevoflurane or desflurane? [J] British Journal of Anaesthesia 2000; 85: 305-7.
[4] Peter K, Conzen P. Inhalational Anaesthesia[ J]. Clinical Anaesthesiology 1993; 7: 898-913.
[5] Ebert TJ, Harkin P, Muzi M. Cardiovascular responses to sevoflurane: a review
[J] .Anesthesia and Analgesia 1995; 81.S11-22.
[6] Smith I, Ding Y, White P. Comparison of induction , maintenance and recovery characteristics of sevoflurane-N2O and propofol-sevoflurane-N2O with propofol-isoflurane-N2O anaesthesia [ J] . Anesthesia and Analgesia 1992; 74: 253-9.
[7] Djaiani GN, Hall JE, Pugh S, Peaston RT. Vital Capacity inhalational induction with sevoflurane: an alternative to standard intravenous induction for patients undergoing cardiac surgery [J] . Journal of Cardiothoracic and Vascular Anesthesia 2001; 15: 169-74.
[8] Knaggs CL, Drummond GB.Randomized comparison of three methods of induction of anaesthesia with sevoflurane [ J] .Br J Anaesth.2005 Aug;95(2): 178-82.
[9] Goodwin N, Campbell AE, Hall JE, Plummer S, Harmer M.A comparison of 8% and 12% sevoflurane for inhalation induction in adults [J] .Anaesthesia.2004 Jan;59(1):15-9.
[10] Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T.A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients [J] .Can J Anaesth. 2003 Jan;50(1):26-31.
[11] Pancaro C, Giovannoni S, Toscano A, Peduto VA.Apnea during induction of anesthesia with sevoflurane is related to its mode of administration[J].Can J Anaesth. 2005 Jun-Jul;52(6):591-4.
[12] Yogendran S, Prabhu A, Hendy A, McGuire G, Imarengiaye C, Wong J, Chung F. Vital capacity and patient controlled sevoflurane inhalation result in similar induction characteristics[J].Can J Anaesth.2005 Jan;52(1):45-9.
[13]Calderón E,Torres LM,Calderón-Pla E.Comparative study of inhalation induction by vital capacity breath in adults using 6%sevoflurane with oxygen or 4.5%sevoflurane in 50%nitrous oxide[J,].Rev Esp Anestesiol Reanim.1999Aug-Sep;46(7):282-5.Spanish.
[14]Siau C,Liu EH.Nitrous oxide does not improve sevoflurane induction of anesthesia in adults[J].J Clin Anesth.2002 May;14(3):218-22.
[15]O'Shea H,Moultrie S,Drummond GB.Influence of nitrous oxide on induction of anaesthesia with sevoflurane[J].Br J Anaesth.2001 Aug;87(2):286-8.
[16]Mapleson WW.Effect of age on MAC in humans:a meta-analysis[J].Br J Anaesth.1996 Feb;76(2):179-85.
[17]Walpole R,Logan M.Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly[J].Br J Anaesth.1999 Jan;82(1):20-4.
[18]TobiasJD,Hirshman CA.Attenuation of histamine-induced airway constriction by albuterol during halothane anesthesia.Anesthesiology[J].1990 Jan;72(1):105-10.
[19]王德龙,刘长庭,张进川.吸烟对老年人肺功能的影响[J].中华老年医学杂志,1999年第3期第18卷.
[20]翁海霞,杨鹏麟,颜静,张素勤,徐定修.吸烟对老年人肺功能的影响[J].临床医学,2005年02期.
[21]Cavalcanti JV,Lopes AJ,Jansen JM,Melo PL.Using the forced oscillation technique to evaluate bronchodilator response in healthy volunteers and in asthma patients presenting a verified positive response[J].J Bras Pneumol.2006;32(2):91-8.
[22]张惠芬,李佩珍,张洪胜等.肺功能的随龄变化:55例通气功能长期随访[J].中华老年医学杂志,1994,13:93-95.
[1] Knaggs CL, Drummond GB.Randomized comparison of three methods of induction of anaesthesia with sevoflurane [J] .Br J Anaesth.2005 Aug;95(2): 178-82.
[2] Goodwin N, Campbell AE, Hall JE, Plummer S, Harmer M.A comparison of 8% and 12% sevoflurane for inhalation induction in adults [J] .Anaesthesia. 2004 Jan;59(1):15-9.
[3] Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T.A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients [J] .Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T.Can J Anaesth. 2003 Jan;50(1):26-31.
[4] Pancaro C, Giovannoni S, Toscano A, Peduto VA.Apnea during induction of anesthesia with sevoflurane is related to its mode of administration[J]. Can J Anaesth. 2005 Jun-Jul;52(6):591-4.
[5]Yogendran S, Prabhu A, Hendy A, McGuire G, Imarengiaye C, Wong J, Chung F. Vital capacity and patient controlled sevoflurane inhalation result in similar induction characteristics [J] .Can J Anaesth. 2005 Jan;52(1):45-9.
[6] Calderón E, Torres LM, Calderón-Pla E.Comparative study of inhalation induction by vital capacity breath in adults using 6% sevoflurane with oxygen or 4.5% sevoflurane in 50% nitrous oxide [J] .Rev Esp Anestesiol Reanim. 1999 Aug-SeP;46(7):282-5. Spanish.
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