依托咪酯脂肪乳在全身麻醉维持中的应用  

The application of etomidate lipid in general anesthesia maintaince

作　　者：王娟[1] 

机构地区：[1]安徽省淮北市淮北矿工总医院麻醉科,235000

出　　处：《中国实用医药》2013年第9期9-11,共3页China Practical Medicine

摘　　要：目的探讨依托咪酯脂肪乳在全身麻醉维持中的可行性。方法选择ASA I或Ⅱ级,年龄18～64岁,需要全身麻醉行腹部手术,开胸手术或开颅手术的患者100例,手术时间应持续1 h以上、4 h以内,术前肝、肾(ALT、AST、BUN、Cr)正常。随机分为依托咪酯组(S组,n=50)和丙泊酚组(F组,n=50),麻醉诱导:插管前5 min静脉注射咪唑安定0.05 mg/kg,插管前3 min静推芬太尼4μg/kg,插管前2 min静推维库溴胺0.1 mg/kg,插管前0.5 min静推依托咪酯0.4 mg/kg(S组)或丙泊酚2 mg/kg(F组),插管前1～2 s静脉注射利多卡因1～1.5 mg。麻醉维持:芬太尼2μg/(kg.min)依托咪酯0.6～0.9 mg/(kg.min)(S组)或丙泊酚4～10 mg/kg(F组),维库溴铵酌情追加,记录入室、插管前、插管即刻,插管后1.3.5 min及切皮时的SBP、DBP、HR、SPO2,诱导期BP和HR的最高和最低值,麻醉时间,手术时间,患者清醒时间,拔管时间。麻醉前,插管后和术后24 h分别经桡动脉抽血2 ml,采用放免法测定血浆皮质醇浓度。观察有无术后躁动、术后知晓、恶心呕吐、浅表性的静脉炎等不良反应,结果①两组患者的麻醉时间,手术时间,手术完毕后的清醒时间以及拔管时间等,比较差异均无统计学意义。②与入室时比较,插管前两组SBP、DBP均明显降低(P<0.05或P<0.01),尤其F组降低更为明显;插管后3、5 min F组SBP、DBP明显降低(P<0.05或P<0.01);插管后1、3 min S组HR明显增快(P<0.05),插管后3、5 min时减慢(P<0.05)(见表1)。③诱导期间两组患者最高SBP、HR和最低SBP、HR的比较差异均无统计学意义。④与麻醉前比较,两组患者在插管后,血浆皮质醇浓度升高(P<0.05或P<0.01),而F组升高更为显著(见表2)。⑤麻醉维持期间患者最高、最低血压或最高、最低心率较患者基础值变化,比较差异均无统计学意义(见表3)。⑥两组比较出现术后躁动、恶心呕吐,术中知晓、过敏反应,浅表性静脉炎等其他不良反应均比较差异无统计Objective To discuss the feasibility of etomidate lipid in general anesthesia maintaince. Methods 100 ASA I or Ⅱ patients aged 18 -64 undergoing abdomenal operation or thoracotomy or craniotomy were selected. The duration of the operation was more than 1 hour and less than 4 hours and the patients＇ liver function, renal function（ALT,AST,BUN,Cr） were normal before the operation. The patients were randomly divided into etomidate group（ S group, n = 50） and propfol group（ F group, n = 50）. Anesthesia induction： 5 min before the intubation, imidazole diazepam 0. 05 mg/kg was intravenously injected, 3 rain before the intubation, fentanyl 4 μg/kg was intravenously injected, 2 min before the intubation, vecuronium 0. 1 mg/kg was intrave- nously injected, 0. 5 min before the intubation, intravenous injection of etomidate 0. 4 mg/kg （ S group ） or propofol 2 mg/kg （ F group） , 1 - 2 seconds before the intubation, intravenous injection of lidocaine 1- 1.5 rag. Maintenance of anesthesia： Constant pace infusion of fentanyl 2 μg/（ kg . min）, etomidate 0. 6 - 0. 9 mg/ （kg. min）（S group） or propofol 4 -10 mg/kg （F group） ,vecuronium was added as need. SBP,DBP,HR, SPO2 of the patients were recorded at different time： just into the operating room, before the intubation, just in- tubation, 1, 3, 5 min after the intubation. The minimum and maximum of Bp and HR during induction, anesthesia time, operation time, the patients＇ revival time and tube drawing time were recorded. 2 ml blood was drew by radialar tery before the anesthesia, after intubation and 24 hours after operation, The plasma cortisol concentration was assayed by radio-immunity. Some untoward effect as dysphoria, anesthesia awareness, nausea, vomit, anaphylaxis, uperficial phlebitis were observed. Results ①theae were no signifficant difference be- tween the two groups＇ anesthesia time, operation time, the patients＇ revival time and tube drawing time of the patientso ②Two groups＇ pre-intubation SBP,DBP decrease

关 键 词：依托咪酯 全身麻醉 术中维持 

分 类 号：R614[医药卫生—麻醉学]