CHANGES OF HEMODYNAMICS AND CATECHOLAMINE CONCENTRATIONS AFTER THE ADMINISTRATION OF 1/200,000 EPINEPHRINE IN ELDERLY PATIENTS

本研究的目的是观察老年病人局麻液中含1/20万肾上腺素后血流动力学和儿茶酚胺浓度的变化。将11例口腔颌面外科患者分为两组，64岁以下患者（组1，N=7）和65岁以上患者（组2，n=4）。静脉注射硫喷妥钠或咪达唑仑诱导麻醉，维库溴铵辅助气管插管。在心血管和呼吸系统稳定后，注入1/20万肾上腺素的0.5%利多卡因溶液，测定血流动力学参数和血清肾上腺素、去甲肾上腺素和多巴胺浓度，结果显示：1组收缩压、舒张压和平均血压下降8.1 ± 10.1%，心率增加9.0%，给予含肾上腺素的利多卡因后80 ~ 90秒，心输出量增加16.5%，总外周阻力降低9.1%。血中肾上腺素浓度对照值为0.051± 0.094ng/ml，120和300秒后分别增加0.647±0.492和0.640± 0.213ng/ml。去甲肾上腺素和多巴胺浓度无明显变化，第2组注射肾上腺素后110 ~ 140秒，收缩压、舒张压和平均血压降低7.6 ~ 8.6%，心率增加6.0%，心输出量增加14.9%，总外周阻力降低17.9%。血中肾上腺素浓度对照值为0.018± 0.012ng/ml，120和300秒后分别增加0.094±0.035和0.173± 0.079ng/ml。未观察到去甲肾上腺素和多巴胺浓度的显著变化。

The purpose of the present study was to investigate the changes of hemodynamics and catecholamine concentrations after the administration of 1/200,000 epinephrine contained in local anesthetic solution in elderly patients. Eleven patients scheduled for oral and maxillofacial surgery were divided into two groups; the patients under 64 years old (group 1, N=7) and over 65 years old (group 2, n=4). Anesthesia was induced with the intravenous administration of thiopental or midazolam, and tracheal intubation was facilitated with the administration of vecuronium. After cardiovascular and respiratory conditions were stabilized, 1/200,000 epinephrine contained in 0.5% lidocaine was infiltrated, then the hemodynamic parameters and the serum concentrations of epinephrine, norepinephrine, and dopamine were measured.In the group 1, systolic, diastolic and mean blood pressure were reduced by 8.1〜10.1%, heart rate increased by 9.0%, cardiac output increased by 16.5%, total peripheral resistance was lowered by 9.1% 80〜90 seconds after the administration of epinephrine contained in lidocaine. The control value of epinephrine concentration in blood was 0.051±0.094 ng/ml, but increased 0.647±0.492 and 0.640±0.213 ng/ml after 120 and 300 seconds, respectively. Norepinephrine and dopamine concentrations did not change significantly.In the group 2, systolic, diastolic and mean blood pressure were reduced by 7.6〜8.6%, heart rate increased by 6.0%, cardiac output increased by 14.9%, total peripheral resistance was lowered by 17.9% 110〜140 seconds after the administration of epinephrine contained in lidocaine. The control value of epinephrine concentration in blood was 0.018±0.012 ng/ml, but increased 0.094±0.035 and 0.173±0.079 ng/ml after 120 and 300 seconds, respectively. No significant changes in norepinephrine and dopamine concentrations were observed.