The Clinical Research Of General Anesthesia Induction With Co-Remifentanil Propofol Target Control Infusion In The Elderly Hypertensive Patients

Objective To investigate the stability of induction period, co-remifentanil propofol Target Control infusion induction in the elderly hypertensive patients. To discuss the difference of cardiovascular reactions in them, provide a more rational and more scientific clinical regimen and theoretical basis for guiding future anesthesia in elderly patients with hypertension.Methods All the cases were from Yanbian university hospital,80case elected to given co-remifentanil propofol Target Control infusion(TCI)induction,The patients were divided into four groups,each group with20. Elimination standard:Obesity or malnutrition, have a history of allergy,have a history of asthma, difficult airway, sever heart lung liver kidney disease. All patients were premedicated with intramuscular atropine0.01mg/kg30minutes before surgery.Group A:aged from35-59, non-hypertension, ASA I; Group B.aged from35-59, hypertension, heart function1-2,ASA Ⅱ; Group Caged from60-85, non-hypertensive,ASA Ⅰ; Group D:aged from60-80, hypertension, heart function1-2,ASA Ⅱ. Anesthesia induction with TCI started by plasma concentration of propofol with1.5mg/L and was increased by0.5mg/L every four minutes.Constant infusion of remifentanil0.2μg/(kg·min)when were in sedation(by Modified Observers Assessment of Alertness/Sedation Scale; MOAA/S; scoring1) Tracheal intubation was facilitated with0.1mg/kg vecuronium by MOAA/S scoring O.After tracheal intubation,the lungs were mechanically ventilated with the pressure-controlled mode,and end-tidal carbon dioxide tension was maintained at30-35mmHg. the date were kept regarding the systolic blood pressure(SBP)、diastolic blood pressure(DBP)、heart rate(HR)、mean arterial pressure(MAP)、stroke volume(SV)、cardiac output(CO)、cardiac indec(CI)、pulse pressure(PP)and systemic vascular resistance(SVR) before induction(TO)、Induction of end(T1)、glottis revealed immediately(T2)、after intubation immediately(T3)、after1min intubation(T4)、3min(T5)、5min(T6)、10min(T8). Results Compared with TO moment:At T1, T2moment four groups of SBP, DBP, MAP decreased obviously(P<0.05), At T3, T4moment has no obvious difference, At T5, T6point decreased obviously(P<0.05); At T1,12, T3, T4, T5, T6moment four groups of CO and SV, HR has no obvious difference; At T1, T2moment group B, C, D the SVR decreased obviously(P<0.05), At T3, T4, T5, T6moment group C, D have no obvious difference, At T4, T5, T6moment group B significantly decreased(P<0.05); At T1, T2moment C, group D PP decreased obviously(P<0.05), At T5, T6moment group D decreased obviously(P<.05). Group A and Group B:At T0～T6momemt,SBP,DBP,MAP,HR,SVR,SV change was no significant significances; At TO momemt,SBP,PP,SVR,MAP was significant significances (P<0.05); At T3momemt,pp were significant significances (P<0.05); Group A and group C:At T0～T6momemt SBP,DBP,MAP, PP was no significant differences; At TO momemt,CO, SVR,PP was significant significances (P<0.05); At T1momemt,CO was significant significances (P<0.05); At T3,T6momemt,CO.,PP was significant significances (P<0.05).Group B and Groups D; At TO-T6moment,CO,SV was no significant differences; At T1,T3,T6momemt, MAP was significant significances (P<0.05); At T0,T3,T6momemt,PP was significant significances (P<0.05). Group C and group D:At T0～T6moment,CO,SV,SVR was no significant differences; At TO,T1,T3,T6momemt,MAP was significant significances significances (P<0.05); At T0,T3momemt, PP was significant significances (P<0.05).Conclusion Elderly patients with Hypertension high SVR, lower CO and SV,SVR fluctuates significantly during anesthesia induction.Remifentanil with TCI propofol induction may effectively inhibit stress responses and reduce or avoid hemodynamic fluctuations in the elderly patiems with Hypertension.