腹腔镜手术丙泊酚和依托咪酯静脉麻醉效果比较及对一氧化氮和内皮素-1的影响  

Comparison of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide and endothelin-1

作　　者：高丽英 王大龙[2] 孙雅静 Gao Liying;Wang Dalong;Sun Yajing(Department of Anesthesiology,Guangrao County People′s Hospital,Shandong Dongying 257300,China;Department of Anesthesiology,Shengli Oilfield Central Hospital,Shandong Dongying 257000,China)

机构地区：[1]山东省广饶县人民医院麻醉科,257300 [2]胜利油田中心医院麻醉科,山东东营257000

出　　处：《中国医师进修杂志》2021年第10期948-951,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨腹腔镜手术患者采用丙泊酚和依托咪酯静脉麻醉的效果比较及对血浆一氧化氮和内皮素-1的影响。方法回顾性分析山东省广饶县人民医院2017年3月至2019年3月80例行腹腔镜手术患者的临床资料。其中采用丙泊酚静脉麻醉40例(丙泊酚组),采用依托咪酯静脉麻醉40例(依托咪酯组)。比较两组患者麻醉效果、麻醉诱导后血浆一氧化氮、内皮素-1、血流动力学指标的变化及不良反应发生情况。结果依托咪酯组意识消失时间、气管插管时间、睁眼时间、恢复自主呼吸时间和言语应答时间均明显短于丙泊酚组[(57.48±2.63)s比(86.17±7.41)s、(4.39±2.56)min比(6.42±2.58)min、(5.39±2.56)min比(9.42±2.58)min、(5.21±1.99)min比(8.75±2.54)min和(8.39±2.56)min比(13.42±2.58)min],差异有统计学意义(P<0.05)。依托咪酯组气腹后0.5、1.0和1.5 h一氧化氮和内皮素-1水平明显低于丙泊酚组,差异有统计学意义(P<0.05)。依托咪酯组插管后收缩压、舒张压和血氧饱和度(SpO2)均明显高于丙泊酚组[(78.42±4.68)mmHg(1 mmHg=0.133 kPa)比(74.11±6.63)mmHg、(132.86±8.71)mmHg比(111.24±3.56)mmHg和0.982±0.032比0.953±0.043],差异有统计学意义(P<0.05)。依托咪酯组不良反应发生率明显低于丙泊酚组[17.5%(7/40)比47.5%(19/40)],差异有统计学意义(P<0.05)。结论与丙泊酚静脉麻醉相比,腹腔镜手术患者采用依托咪酯静脉麻醉时血流动力学更稳定,麻醉效果更好,有效抑制一氧化氮和内皮素-1的释放,且安全性较高。Objective To compare the effects of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide(NO)and endothelin-1(ET-1).Methods The clinical data of 80 patients with laparoscopic surgery in Guangrao People′s Hospital from March 2017 to March 2019 were retrospectively analyzed.Among them,40 cases were given propofol intravenous anesthesia(propofol group),and 40 cases were given etomidate intravenous anesthesia(etomidate group).The anesthetic effect,plasma NO and ET-1 levels,hemodynamic indexes and adverse reactions(muscle spasm,nausea and vomiting,injection site pain,body movement and respiratory depression)were compared between the two groups.Results The time of consciousness disappearance,tracheal intubation,eye opening,spontaneous breathing and speech response in etomidate group were significantly shorter than those in propofol group:(57.48±2.63)s vs.(86.17±7.41)s,(4.39±2.56)min vs.(6.42±2.58)min,(5.39±2.56)min vs.(9.42±2.58)min,(5.21±1.99)min vs.(8.75±2.54)min and(8.39±2.56)min vs.(8.39±2.56)min,and the differences were statistically significant(P<0.05).The levels of NO and ET-1 in the etomidate group were significantly lower than those in the propofol group at 0.5,1.0 and 1.5 h after pneumoperitoneum(P<0.05).The levels of systolic blood pressure,diastolic blood pressure and oxygen saturation(SpO2)in the etomidate group were significantly higher than those in the propofol group:(78.42±4.68)mmHg(1 mmHg=0.133 kPa)vs.(74.11±6.63)mmHg,(132.86±8.71)mmHg vs.(111.24±3.56)mmHg and 0.982±0.032 vs.0.953±0.043,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the etomidate group was significantly lower than that in the propofol group:17.5%(7/40)vs.47.5%(19/40),P<0.05.Conclusions Compared with propofol intravenous anesthesia,etomidate intravenous anesthesia in laparoscopic surgery patients has more stable hemodynamics and better anesthetic effect.It can effectively inhibit the r

关 键 词：二异丙酚 依托咪酯 麻醉 静脉 一氧化氮 内皮缩血管肽1 

分 类 号：R614[医药卫生—麻醉学]