Clinical Research On Influences Of Combination Induction Of Propofol And Sevoflurane On Hemodynamic Changes In Elderly Patients

Objective:Propofol has a large impact on hemodynamics,which often causes obvious hemodynamic fluctuations in elderly patients with poor cardiovascular regulating function and increases the perioperative risk significantly.Sevoflurane is a common new-type inhaled anesthetic agent,which has faster onset of anesthesia induction,muscle relaxant and analgesia,good controllability,and good anesthesia advantages.Patients could faster recovery from the anesthesia.Elderly patients using sevoflurane induction,has smaller blood flow fluctuation,but the inhalation induction of sevoflurane is often difficult to be accepted by patients,and some patients appear complications such as increased heart rate during inhalation of sevoflurane.This paper intends to find a way suitable for anesthesia induction of elderly patients with simple sevoflurane induction,simple propofol induction and combined induction in three groups of patients,respectively.Methods:With the approval of the hospital ethics committee,90 patients who were selected to suffer gastrointestinal surgery under general anesthesia between January 2015 and October 2015 were selected as the research objects.Patients for surgery were numbered with the random number table method and were randomly divided into three groups:group S（sevoflurane）,group P（propofol）and group SP（propofol and sevoflurane）,with 30 cases in each group.Patients of group S were induced with inhalational sevoflurane（6%sevoflurane+6 L/min oxygen）,patients of group P were induced with intravenous infusion of propofol（target plasma of 3μg/ml）,and group SP was induced by the combination of the two methods but half dose.The three gro ups of elderly patients were recorded for hemodynamic parameters,such as systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,mean arterial pressure（MAP）before induction（T₀）,immediately before endotracheal intubation（T₁）,immediately（T₂）,1min（T₃）,3 min（T₄）and 5 min（T₅）after endotracheal intubation,and incidences of adverse reactions such as bradycardia,tachycardia,choking.cough,intravenous pain and agitation during anesthesia induction.The results were recorded and compared.Results:（1）There were no statistically significant differences among three groups of patients in gender ratio,age,body height,body weight and metabolic equivalent（MET）（P>0.05）,but they were comparable.（2）Heart rate:All of the three groups had lower heart rate on average after induction,and the differences were of statistical significance（P<0.05）;average heart rate of three groups were higher after intubation,and the differences were of statistical significance（P<0.05）,where the change ranges of group S and group P were higher than that of group SP;there were no statistically significant differences between heart rate after T₄ and heart rate at T₁ in all of the three groups（P>0.05）.（3）Blood pressure:SBP and DBP were lowe r after induction than before anesthesia induction in all of the three groups,with statistically significant differences（P<0.05）;and after anesthesia induction,SBP and DBP of group SP were higher than that of group S and group P;There were statistically significant differences among three groups in SBP and DBP after intubation（P<0.05）;it reached the highest pressure at T₃ and then gradually fell to the blood pressure level before intubation,but the change of blood pressure in group SP was relatively small.（4）Incidence of agitation in group S was higher than that of group P and group SP;incidence of choking,cough and intravenous pain was higher in group P than that of group S and group SP,while incidence of adverse reactions was lower in group SP than that of group S and group P,and all of the differences were statistically significant（P<0.05）.Conclusion:Target-controlled intravenous infusion of propofol and inhalation induction of sevoflurane as well as their combination can all produce good inhibitory effect to the patient’s intubation response.However,combination of sevoflurane and propofol could reduce the usage of the two anesthetic agents in elderly patients,which has smaller impact on hemodynamics in the elderly,help them to safely and smoothly pass through the induction period,with low incidences of adverse reactions.So this induction method can be used for anesthesia induction in elderly patients.