依托咪酯靶控输注对老年肿瘤患者肾上腺皮质功能的影响  

The effects of target-controlled infusion etomidate on the adrenal cortex function in perioperative period of elderly patients

作　　者：刘晓飞[1] 徐刚[1] 任柏林[1] 

机构地区：[1]河南省肿瘤医院麻醉科,郑州市450003

出　　处：《临床麻醉学杂志》2010年第10期846-848,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨靶控输注(TCI)依托咪酯对老年肿瘤患者围手术期肾上腺皮质功能的影响。方法全麻下年龄65～75岁老年择期手术患者60例(食管癌患者23例,肺癌12例,肝癌10例,宫颈癌8例,甲状腺癌7例),男39例,女21例,ASAⅠ或Ⅱ级。随机均分为依托咪酯组(E组)和丙泊酚组(P组)。术中麻醉维持E组TCI依托咪酯1μg/ml;P组TCI丙泊酚2～4μg/ml。采用放射免疫分析方法检测诱导前(T1)、麻醉诱导后30min(T2)、2h(T3)、24h(T4)、48h(T5)患者血清中的皮质醇(Cor)、醛固酮、促肾上腺皮质激素(ACTH)浓度。结果与T1时比较,T2～T4时E组Cor浓度、T3时醛固酮浓度明显降低、而T3时ACTH浓度明显升高(P<0.05);T2、T3时P组Cor、醛固酮浓度升高,T4时患者血清中的Cor、醛固酮、ACTH浓度基本恢复到T1时水平,但差异无统计学意义。T2～T4时E组Cor浓度较P组明显降低(P<0.05);T2、T3时E组点醛固酮浓度较P组降低、ACTH浓度较P组升高(P<0.05)。结论依托咪酯TCI对老年患者围手术期肾上腺皮质的抑制作用超过24h,但Cor已经恢复到诱导前水平的70%以上,48h基本恢复到原有水平。Objective By means of target-controlled infusion etomidate, to explore the the effects of target-controlled infusion etomidate on the adrenal cortex function in perioperative period of elderly patients. Methods Choose 60 cases of elderly patients under general anesthesia （23 cases of esophageal cancer, 12 cases of lung cancer, 10 cases of liver cancer, 8 cases of cervical cancer, 7 cases of thyroid cancer）, aged 65 75 years, 39 cases of male, 21 cases of female,ASA Ⅰ or Ⅱ level. They were randomly divided into Etomidate group （group E, n= 30） andpropofol group （group P, n= 30）. To maintain anesthesia Group E TCI etomidate 1 μg/ml; group P TCI propofol 2-4 μg/ml. Used radioimmunoassay to detect serum cortisol, aldosterone, adrenocortieotropic hormone （ACTH） concentrations before anesthesia （T1）, 30 min （T2）, 2 h （T3）, 24 h （T4）, 48 h （T5） after induction of anesthesia. Results Group comparison Group P： Cortisol, aldosterone concentration increased at T2, T3. Serum cortisol, aldosterone, ACTH concentration recoveried to the base level （T1） at T4. Group E： Cortisol and aldosterone concentration decreased at T2, T3（P〈0.05）; Serum cortisol return to 72. 28% of cortisol levels before induction at T4 and at T5 point back to the level before induction. ACTH concentration increased at Ta （P〈0.05） and aldosterone, ACTH was basically restored to its former level at T4 point. Between the two groups It was statistically significant difference in cortisol concentrations at T2, T3, T4 between the two groups （P 〈 0. 05）. And aldosterone, ACTH concentration was statistically significant difference at T2, T3 （P 〈 0.05）. Conclusion The inhibition of adrenal cortex by etomidate intravenous target-controlled infusion for anesthesia maintenance exceed 24 h, but cortisol has been restored to the level before induction over 70% and restored to the original level after 48 h.

关 键 词：依托咪酯 靶控输注 老年 皮质醇 肾上腺皮质功能 

分 类 号：R614[医药卫生—麻醉学]