咪唑安定和依托咪酯静脉诱导对冠脉搭桥病人血流动力学和氧代谢的影响  

The effect of induction with etomidate or midazolam on the hemodynamics and oxygen consumption in patients with coronary heart disease

作　　者：程卫平[1] 王宇红[1] 

机构地区：[1]中国医学科学院

出　　处：《中华麻醉学杂志》1997年第11期646-649,共4页Chinese Journal of Anesthesiology

摘　　要：目的:观察咪唑安定和依托咪酯诱导对冠心病病人血流动力学和氧代谢的影响。方法:30例行冠脉搭桥手术的病人,随机分为E组(依托咪酯组,n=15)和M组(咪唑安定组,n=15)。在两组病人分别给予咪唑安定或依托咪酯直至睫毛反射消失,继之根据动脉压的变化给予哌库溴胺和芬太尼诱导麻醉,气管插管。观察诱导前、中、后两组病人血流动力学和整体氧代谢的改变。结果:麻醉诱导使两组病人HR、MAP、SVRI、PVRI和VO_2I均明显下降(P<0.05),但与E组相比,M组MAP和SVRI下降更为明显(P<0.05)。同时M组的RVSWI、LVSWI、RVSWI×HR和LVSWI×HR明显下降,而E组无明显改变(P<0.05)。插管后两组的HR、MAP、SVRI和PVRI均有回升。但在E组HR未恢复到诱导前水平,在M组MAP和SVRI未恢复到诱导前水平(P<0.05)。插管后两组病人RVSWI×HR和LVSWI×HR无明显差别。两组病人在诱导过程中CI和DO_2I均无明显改变。结论:与依托咪酯相比咪唑安定与芬太尼合用有较强的协同扩血管作用。依托咪酯诱导可维持较好的心肌氧供、需平衡,更适用于冠脉储备有限的冠心病病人的诱导。Objective: To evaluate the hemodynamics and oxygen consumption following induction of anesthesia with etomidate or midazolam in patients with coronary heart disease(CAD). Method: Thirty patients were divided into E (etomidate,n=15)and M(midazolam,n=15)groups,receiving a infusion of etomidate or midazolam until their eyelash reflex was lost. After pipeuronium(0.15mg/kg) and fentanyl were administered according to the mean blood pressure,the intubetion was achieved. Hemodynsmic and oxygen data were measured before induction, during induction and 1 min after intubation. Result: Induction caused a significant fall in HR,MAP,SVRI,PVRI and VO_2I in both groups (P<0.05),but HR,MAP and SVRI decreased more in M group(P<0.05). Induction also caused a significant decrease in RVSWI,LVSWI,RVSWI×HR and LVSWI×HR in M group but not in E group (P<0.05). After intubation,the HR,MAP,SVRI,PVRI returned,but HR did not reached the pre-induction level in E group and MAP,SVRI did not reached the pre-induction level in M group (P<0.05). After intubation, the RVSWI×HR and LVSWI×HR were not significantly different between two groups. The CI and DO_2I had no change in both groups during whole procedure. Conclusion: Combined with fentanyl,midazolam has more profound vasodilator action than that of etomidate.Induction with etomidate can maintain a good balance between myocardial oxygen delivery and consumption,more suitable for patients with limited coronary reserve.

关 键 词：依托咪酯 咪唑安定 血液动力学 冠状动脉搭桥术 

分 类 号：R654.205[医药卫生—外科学] R971.2[医药卫生—临床医学]