依托咪酯脂肪乳在肝叶切除手术中的应用  

Application of Etomidate Fat Emulsion in Liver Lobectomy

作　　者：刘志贵[1] 屈常伟[1] 蒋德斌[1] 骆喜宝[1] 

机构地区：[1]桂林医学院附属医院麻醉科,广西桂林541001

出　　处：《医学临床研究》2013年第7期1264-1266,共3页Journal of Clinical Research

基　　金：广西区卫生厅计划课题基金项目（Z2012399）

摘　　要：【目的】观察依托咪酯脂肪乳靶控输注在肝叶切除手术中的麻醉效果和不良反应，并与丙泊酚进行比较。【方法】择期行肝叶切除手术患者40例（ASAI～II），随机分为依托咪酯脂肪乳组（E组）和丙泊酚组（P组），每组20例。E组靶控输注依托咪酯脂肪乳进行麻醉诱导并维持，P组靶控输注丙泊酚，维持脑电波双频指数（BIS）40～60。手术结束前10min停用依托咪酯脂肪乳或丙泊酚。记录两组麻醉前、插管前1rain、插管后1min、3rain、5min、切皮时、手术结束时的收缩压（SBP）、舒张压（DBP）、心率（HR）、B1S，并记录苏醒时间、合并用药情况及不良反应。【结果】与基础值比较，插管前1rain及插管后3rain、5rain，两组的SBP、DBP均显著降低（P〈0．05），插管后3min、5min及手术切皮时，P组HR显著下降（P〈0．05）。诱导后各时间点的BIS值均随着麻醉的加深呈进行性下降，与诱导前基础值比较差异有显著性（P〈0．05），但两组间各时间点比较差异无显著性（P〉0．05）。P组麻黄素、阿托品的使用率高于E组，不良反应发生率低于E组，但差异无显著性（P〉0．05）。E组苏醒时间显著长于P组（P〈O．05）。【结论】在肝叶切除手术中，依托咪酯脂肪乳较丙泊酚更有利于血流动力学稳定，但苏醒时间延长，术后恶心呕吐的发生率增加。[Objective]To observe the anesthesia effect and adverse reaction of etomidate fat emulsion by target-con- trolled infusion in liver lobeetomy, and compare them with propofol. [Methods]Forty patients undergoing elective lobe re- section surgery（ASA I -II） were randomly divided into etomidate fat emulsion group（group E） and propofol group（group P） with 20 cases in each group. Group E received etomidate fat emulsion by targevcontrolled infusion for anesthesia in duction and maintenance, while group P received propofol by target-controlled infusion. Dual frequency index（BIS） of e- lectroencephalography was maintained 40460. Etomidate fat emulsion or propofol was stopped at 10min before the end of surgery. Systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR） and BIS of two groups before an- esthesia, 1rain before intubation, lmin, 3min and 5 min after intubation and at skin cutting were recorded. The awake time, drug combination and adverse reactions were recorded. [Results]Compared with baseline values, SBP and DBP of two groups at lmin before intubation and 3min and 5min after intubation all significantly decreased（ P 〈~0.05）. HR of group P at 3min and 5rain after intubation and at skin cutting declined significantly（ P 〈0.05）. Compared with baseline values before induction（T0 ）, the BIS values in each time after induction decreased progressively with anesthesia deepe- ning, and there was significant difference（ P 〈0.05）. But there was no significant difference at each time point between two groups（ P 〉0.05）. The usage of ephedrine and atropine in P group was higher than that in group E, and the inci- dence of adverse reaction was lower than that in group E, but there was no significant difference（ P 〉0.05）. The awake time in group E was significantly longer than that in group P（ P 〈0.05）. [Conclusion] Compared with propofol, etomid- ate fat emulsion in liver lobectomy is more helpful for hemodynamic stability, but prolongs th

关 键 词：肝切除术 依托咪酯 脂肪乳剂 静脉注射用 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]