依托咪酯和丙泊酚对急诊脑血管介入手术患者全麻诱导期心率变异性的影响  

Effect of Etomidate and Propofol on Hemodynamics and Heart Rate Variety during Rapid Sequence Induction in Emergency Brain Interventional Neuroradiology Patients

作　　者：单宇[1] 李颖川[1] 严海[1] 胡伟国[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《中国临床医学》2011年第1期87-89,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察依托咪酯和丙泊酚对急诊颅脑介入手术患者全麻诱导插管时心率变异性的影响。方法:选择急诊颅脑介入手术的清醒患者30例,随机分为丙泊酚组(A组15例)和依托咪酯组(B组15例),采用丙泊酚或依托咪酯、罗库溴铵、芬太尼进行快速序贯诱导,分别于诱导前5min(T0)、插管前即刻(T1)和插管后5min(T2)记录和比较患者的血压、心率、外周氧饱和度(SpO2)、心率变异性(HRV)的变化。结果:①T1时A组收缩压(SAP)和舒张压(DAP)较B组均显著下降(P<0.05);T2时A组SAP较B组SAP显著下降(P<0.05),DAP则无显著差异;2组心率(HR)在T1、T2时均无显著差异。②A组在T1、T2时低频(LF)、高频(HF)、LF/HF、总功率谱(TP)均较T0有显著下降(P<0.05);B组在T1时LF、HF、TP较T0有显著下降(P<0.05),但LF/HF与T0比较,差异无统计意义;组间比较,在T2时A组LF、LF/HF较B组有显著降低(P<0.05)。结论:依托咪酯在急诊颅脑介入手术全麻快速序贯诱导过程中虽然抑制心率变异性,但在保持植物神经功能和血流动力学的相对稳定性方面优于丙泊酚。Objective：To compare the effects of etomidate and propofol on hemodynamics and heart rate variety（HRV） for rapid sequence induction in emergency brain interventional neuroradiology（INR） patients.Methods： Thirty awake patients for emergency brain INR surgery were selected in the study and randomly assigned into two groups,the propofol group（Group A,n=15）and the etomidate group（Group B,n=15）.Rapid sequence induction by fentanyl,rocuronium,propofol or etomidate was used for all patients.Collected data included blood pressure,heart rates,oxygen saturation（SpO2）,heart rate variability（HRV） at 5 minutes before induction,just before intubation and 5 min after intubation.Results： At T1,the SAP and DAP in group A dropped dramatically（P0.05）.The SAP in group A at T2 decreased more significantly than those in group B,while the DAP had no difference between two groups at that time points（P0.05）.The heart rates were similar in the two groups at T1 and T2.In group A,LF,HF,LF/HF and TP dropped remarkably at T1 and T2 comparing with those at T0（P0.05）.The results in Group B were similar to Group A except that the LF/HF had no changes among T0,T1 and T2.Compared with group B,the LF and LF/HF fell more in group A at T2（P0.05）.Conclusions：Although etomidate suppress HRV,it has more stable haemodynamic and nerve autonomici function than propofol for emergency brain INR under rapid sequence induction.

关 键 词：依托咪酯 丙泊酚 颅脑介入 血流动力学 心率变异性 

分 类 号：R614.2[医药卫生—麻醉学]