持续静脉输注依托咪酯对老年患者循环系统及免疫应激反应的影响  

Effects of Continuous Intravenous Infusion of Etomidate on Circulation System and Immune Stress Reaction in Elderly Patients

作　　者：柴林[1] 甘建辉[1] 刘智慧[1] 宋巧凤[1] 周文华[1] 高慧军[1] 柳浩然[1] 

机构地区：[1]唐山市人民医院,河北唐山063000

出　　处：《中国药房》2013年第32期3002-3004,共3页China Pharmacy

基　　金：唐山市科学技术研究与发展指导计划(NO.12130295b)

摘　　要：目的:观察持续静脉输注依托咪酯对老年患者循环系统及免疫应激反应的影响。方法:选择行择期手术的老年患者60例,按随机数字表法均分为依托咪酯组(E组)和丙泊酚组(P组)。P组诱导药物为丙泊酚200mg/20ml,1.5～2mg/kg;E组为依托咪酯20mg/10ml,0.2～0.3mg/kg。插管后行机械通气,间断静脉注射芬太尼0.1mg/2ml,3～5μg/kg和顺式阿曲库铵20mg/支,0.1mg/kg。麻醉维持期间E组静脉持续输注依托咪酯0.4～0.6mg(/kg·h),P组静脉持续输注丙泊酚4～6mg(/kg·h)。于麻醉诱导前(T0)、给药后1h(T1)、术毕(T2)、术后6h(T3)及术后24h(T4)测定血糖、肾上腺素和皮质醇含量的变化,并记录T0、麻醉诱导后(Ta)、插管后(Tb)、T1及T2的血压和心率变化。结果:两组患者与各自T0时的血糖比较,T1及T2时均显著上升,差异有统计学意义(P<0.05),组间比较,T1及T2时P组血糖较E组显著上升,差异有统计学意义(P<0.05);两组患者与各自T0时的肾上腺素比较,T1、T2及T3时均显著上升,差异有统计学意义(P<0.05);两组患者皮质醇与各自T0时比较,E组皮质醇在T1、T2及T3时均显著降低,差异有统计学意义(P<0.05)。两组患者血压与各自T0时比较,P组收缩压和舒张压在Ta及Tb时均显著下降,差异有统计学意义(P<0.05)。手术期间两组患者血流动力学稳定、心率无显著变化且均未见不良反应发生。结论:持续静脉输注依托咪酯对老年患者的血糖、肾上腺素、皮质醇及免疫应激反应影响均较小,可安全用于老年患者的静脉麻醉维持。OBJECTIVE：To observe the influence on circulation system and immune stress reaction in elderly patients.METHODS：60 elderly patients undergoing selective operation collected were randomly divided into 2 groups,i.e.etomidate group（group E）and propofol group（group P）.Induced drugs of anaesthesia was propofol 200 mg/20 ml,1.5-2 mg/kg in group P,and etomidate 20 mg/10 ml,0.2-0.3 mg/kg in group E.Both groups received mechanical ventilation after intubation,interrupted intravenous injection of fentanyl 0.1 mg/2 ml,3-5 μg/kg and cis-atracurium 20 mg/piece 0.1 mg/kg.Group E was given continuous intravenous infusion of etomidate 0.4-0.6 mg（/kg·h）and group P was given continuous intravenous infusion of propofol 4-6 mg（/kg· h）to maintain anesthesia.The changes of blood glucose,adrenaline and cortisol were determined before induction of anesthesia（T0）and 1h after treatment（T1）,at the end of operation（T2）,6 h after operation（T3）and 24 h after operation（T4）.The changes of blood pressure and heart rate were recorded at T0,after induction of anesthesia（Ta）,after intubation（Tb）,T1 and T2.RESULTS：Compared with the T0,blood glucose of 2 groups increased significantly at T1 and T2;there was statistical significance（P0.05）.Compared with group E,blood glucose of group P increased significantly at T1 and T2;there was statistical significance（P0.05）.Compared with the T0,the levels of epinephrine increased significantly in 2 groups at T1,T2 and T3,there was statistical significance（P0.05）.Compared with the T0,the level of cortisol in group E decreased significantly at T1,T2 and T3;there was statistical significance（P0.05）.Compared with T0,Both systolic and diastolic pressures of group P decreased significantly at Ta and Tb（P0.05）.Hemodynamics and heart rate had no significant change,and no ADR was found in 2 groups.CONCLUSIONS：Etomidate has slight influence on blood glucose,epinephrine,cortisol and immune stress reaction in elderly patients undergoing selective ope

关 键 词：依托咪酯 老年 血糖 肾上腺素 皮质醇 

分 类 号：R614.24[医药卫生—麻醉学]