依托咪酯复合麻醉下脊柱侧弯矫形术患者术中唤醒试验的质量  

Quality of intraoperative wake-up test in patients undergoing scoliosis correction surgery under etomidate-based anesthesia

作　　者：胡礼宏[1] 谢道奋[1] 徐霞[1] 韩新生[2] 陈小非[1] 张明[3] 

机构地区：[1]宁波大学医学院附属李惠利医院麻醉科,315000 [2]西安交通大学医学院第二附属医院麻醉科 [3]宁波大学医学院附属李惠利医院骨科,315000

出　　处：《中华麻醉学杂志》2015年第5期574-576,共3页Chinese Journal of Anesthesiology

摘　　要：目的：评价依托咪酯复合麻醉下脊柱侧弯矫形术患者术中唤醒试验的质量。方法择期行脊柱侧弯矫形术患者30例，性别不限，年龄13～32岁，体重40～65 kg，ASA分级Ⅰ或Ⅱ级，按照随机数字表法分为2组（ n＝15）：依托咪酯组（ E组）和异丙酚组（ P组），2组分别静脉注射依托咪酯0．3 mg∕kg和异丙酚2 mg∕kg，均采用咪达唑仑、芬太尼、罗库溴铵麻醉诱导，经鼻气管插管后行机械通气，术中 E 组和 P 组分别持续静脉输注依托咪酯0．6～1．2 mg · kg-1· h-1和异丙酚8～10 mg·kg-1·h-1，2组均采用瑞芬太尼和顺阿曲库铵维持麻醉。唤醒试验前停止输注顺阿曲库铵，于唤醒前15 min将异丙酚剂量调整为4 mg·kg-1·h-1，当术中脊柱操作及牵拉完成后，2组分别停止输注异丙酚和依托咪酯，并下调瑞芬太尼至0．025μg·kg-1·min-1。记录唤醒时间、唤醒试验质量评级，于麻醉前（ T0）、唤醒前即刻（ T1）、对指令有反应（ T2）和加深麻醉后（ T3）记录MAP和HR，于T0、手术结束时（ T4）、术后24 h（ T5）时抽取颈内静脉血样，采用放射免疫法测定血浆皮质醇浓度。结果2组患者均唤醒成功，唤醒时间、唤醒试验质量评级及各时点HR、MAP和血浆皮质醇浓度差异无统计学意义（ P＞0．05）；与T0时比较，2组T2时HR和MAP升高（ P＜0．01），2组术中唤醒期间MAP和HR均在正常范围内，未发生严重心血管事件。结论依托咪酯复合麻醉下脊柱侧弯矫形术患者术中唤醒试验的质量较好，与异丙酚复合麻醉相似。Objective To evaluate the quality of intraoperative wake-up test in the patients undergoing scoliosis correction surgery under etomidate-based anesthesia. Methods Thirty patients of both sexes, aged 13-32 yr, weighing 40-65 kg, of ASA physical statusⅠorⅡ, undergoing elective scoliosis correction surgery, were randomly assigned into etomidate group （ group E, n=15 ） or propofol group （group P, n=15） using a random number table. Anesthesia was induced with etomid 0.3 mg∕kg （group E） or propofol 2mg∕kg （ group P ） injected intravenously, midazolam, fentanyl and rocuronium. The patients were mechanically ventilated after naso-tracheal intubation. Etomidate 0.6-1. 2 mg · kg-1 · h-1 and propofol 8- 10 mg·kg-1 ·h-1 were infused intravenously during surgery in E and P groups, respectively. Both remifentanil and cisatracurium were used for maintenance of anesthesia in the two groups. Cisatracurium infusion was stopped before wake-up test. The infusion rate of propofol was adjusted to 4 mg·kg-1 ·h-1 at 15 min before wake-up test. After the scoliotic angle was corrected, infusion of etomidate and propofol was stopped, and the infusion rate of remifentanil was adjusted to 0.025μg·kg-1 ·min-1 in both groups. The wake-up time was recorded, and the quality of wake-up was assessed. Mean arterial pressure （MAP） and heart rate were recorded before anesthesia （ T0 ） , immediately before the patients were awakened （ T1 ） , when the patients responded to commands from doctors （ T2 ） , and after anesthesia was deepened （ T3 ） . At T0 , the end of surgery （ T4 ） , and 24 h after surgery （ T5 ） , blood samples were collected from the internal jugular vein for determination of plasma cortisol concentrations. Results The patients were awakened successfully in the two groups, and there were no significant differences in the wake-up time, quality of wake-up, and MAP, HR and plasma cortisol concentrations at each time point between the two groups. MAP and HR were significantly high

关 键 词：依托咪酯 二异丙酚 脊柱侧凸 唤醒试验 

分 类 号：R614[医药卫生—麻醉学]