依托咪酯乳剂静脉麻醉在高龄产妇患者手术中的临床应用探讨  

Clinical application of etomidate emulsion intravenous anesthesia in patients with advanced maternal age in the surgical

作　　者：谢柏旺[1] 

机构地区：[1]湖南省永州职业技术学院附属医院麻醉科,湖南永州425000

出　　处：《中国当代医药》2012年第1期70-71,共2页China Modern Medicine

摘　　要：目的:对依托咪酯乳剂用于高龄产妇全凭静脉麻醉(TIVA)的可行性和效果进行探讨和分析。方法:对本院2007年3月～2010年3月收治的40例高龄产妇,随机将其分为实验组和对照组,每组各20例。对实验组产妇行依托咪酯复合瑞芬太尼麻醉,对照组行丙泊酚麻醉,对实验组的产妇行剂量为10～15μg/(kg·min)依托咪酯乳剂麻醉,对照组维持剂量为6～10mg/(kg·h)的丙泊酚,实验组和对照组均联合瑞芬太尼泵注。分别选取麻醉前(T1),麻醉后(T2),术后2h(T3),术后24h(T4)观察产妇的血浆皮质醇、心血管反应、患者术后的恢复情况。结果:在血流动力学方面实验组的波动要明显低于对照组的波动水平;实验组和对照组产妇在术中术后的血浆皮质醇都在正常范围内有不同程度的降低;在产妇手术结束时(T3)产妇血皮质醇的含量降低最为显著(P<0.05),实验组的皮质醇水平显著低于对照组(P<0.05);在术后24h后,产妇血皮质醇水平恢复至正常水平。结论:依托咪酯对产妇的影响要小于丙泊酚,更加适合高龄产妇的麻醉维持;依托咪酯可以对肾上腺皮质做短暂的抑制,对高龄产妇可以安全的进行静脉麻醉。Objective： To discuss and analyse the feasibility and effect of etomidate emulsion total intravenous anesthesia （TIVA） in patients with advanced maternal age. Methods： Forty cases of older parturient in our hospital from March 2007 to March 2010 were randomly assigned to the experimental group and the control group, each group of 20 cases. The experimental group were treated with etomidate comlplex remifentanyl anesthesia, etomidate 10-15 μg/（kg·min）, and the control group were treated with propofol anesthesia, 6-10 mg/（kg·h）, both groups were combined remifentanyl pump. We selected before anesthesia （T1）, anesthesia （T2）, 2 h after anesthesia （T3）, postoperative 24 h （T4）, observed of the plasma cortisol, maternal cardiovascular reaction, the postoperative recovery. Results： The wave of blood flow dynamics experimental group was lower than those of the control group; Cortisol in and after the operation of two groups both decreased of different level in the normal range; In the end of the maternal surgery （T3） cortisol levels were low in maternal blood in the most significant （P0.05）, and the cortisol levels was significantly lower than that of control group （P0.05）; After 24 hours after surgery, the maternal blood cortisol levels restored to normal levels; The awakening time of experimental group after operation was shorter than that of control group （P0.05）. Conclusion： Etomidate has smaller influence to puerpera than propofol, is more suitable for elderly tabor phenol women anesthesia maintain; it can make transient suppression to adrenal cortex, is safely for intravenous anesthesia in patients with advanced maternal age.

关 键 词：依托咪酯 高龄产妇 丙泊酚 全凭静脉麻醉 

分 类 号：R614.24[医药卫生—麻醉学]