依托咪酯与丙泊酚联合靶控输注全麻对中老年患者血流动力学影响的临床比较  

Etomidate and propofol target controlled infusion of elderly patients with general anesthesia hemodynamic effects of clinical comparison

作　　者：王玥[1] 康凯[1] 张国刚[1] 郑琳[1] 徐铭军[1] 

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,100026

出　　处：《北京医学》2016年第5期455-457,共3页Beijing Medical Journal

摘　　要：目的观察依托咪酯与丙泊酚在中老年患者全麻诱导与麻醉维持中对血流动力学的影响及不良反应的发生情况。方法选择拟在全麻下行妇科腹腔镜手术的中老年患者,年龄55~65岁,美国麻醉医师协会麻醉风险评分（ASA）Ⅰ~Ⅱ级纳入本研究。纳入患者被随机分为3组,分别为丙泊酚组（P组）、依托咪酯组（E组）、丙泊酚依托咪酯联合组（L组）,每组20例。P组采用丙泊酚靶控诱导与术中维持,E组采用依托咪酯靶控诱导与术中维持,L组采用依托咪酯靶控诱导后改用丙泊酚靶控术中维持。术中根据患者生命体征和脑电双频指数（BIS）值调整药物输注速度,记录入室（T0）、插管前1 min（T1）、插管即刻（T2）,插管后1 min（T3）、5 min（T4）,切皮（T5）、拔管（T6）时的平均动脉压（MAP）和心率（HR）;记录手术时间、停药后到患者苏醒睁眼的时间、停药后到拔除气管导管的拔管时间及定向力恢复时间及术后不良反应的发生情况。结果 60例患者纳入本研究,每组20例。P组患者的MAP和HR在T1时明显低于T0时点（P〈0.05）,T3、T6时MAP和HR升高;E组和L组患者的MAP和HR在T1~T4时与T0时点比较无显著变化。E组拔管时间略有延长;所有患者均无肌颤、术中知晓和血栓性静脉炎的发生,P组有9例（45.0%）出现注射痛,明显高于其余2组（P〈0.05）;E组有4例（20.0%）出现恶心呕吐,明显高于其余2组（P〈0.05）。结论依托咪酯用于全麻诱导使中老年患者的血流动力学趋于平稳,用于术中维持造成苏醒延长,更适合与丙泊酚联合应用。Objective To observe etomidate induction of general anesthesia with propofol in elderly patients with anesthesia to maintain influence on hemodynamics and the occurrence of adverse reactions. Methods The elderly patients who were going to undertake gynecologic laparoscopic surgery, aged 55 to 65 years old, ASA Ⅱ~Ⅱ level were enrolled in the study, and randomly divided into three groups, propofol group（P group）, etomidate group（group E）, propofol etomidate group（group L）. Propofol target controlled induction and intraoperative maintenance were used in P group,etomidate target induction and intraoperative maintenance were used in E group, etomidate target controlled induction and switch to propofol target maintain were used in L group. Drug infusion speed was adjusted according to the patients＇ vital signs and BIS value, MAP and HR value were recorded at home invasion（T0）, 1 min before intubation（T1）, immediate intubation（T2）, 1 min（T3）, 5 min after intubation（T4）, cut skin（T5）, tube drawing（T6）. The operation time, waking him only to patients after discontinuation of time, to root out the endotracheal tube after discontinuation of time and the directional force recovery time and postoperative adverse reactions occur were recorded. Results Sixty patients were enrolled into the study, twenty patients in each group. MAP and HR at T1 in P group were significantly lower than T0（P〈0.05）,MAP and HR elevated at T3, T6. Compare to T0, there were no significant changes of MAP and HR at T1-T4 in the E and L group. Decannulation time in group E prolonged slightly. There were no muscle tremor, intraoperative awareness and thrombophlebitis in all the patients. Nine cases（45.0%） occurred injection pain in P group, which was obviously higher than those of the other two groups（P〈0.05）, 4 cases（20.0%） occurred nausea and vomiting in group E, which was higher than the other two groups（P〈0.05）. Conclusion Etomidate used for induction of general anesthesia in the

关 键 词：靶控输注 血流动力学 苏醒时间 

分 类 号：R614[医药卫生—麻醉学]