依托咪酯与地塞米松联合用药对全麻老年患者皮质醇分泌的影响  

Effect of etomidate and dexamethasone on cortisol secretion in elderly patients undergoing general anesthesia

作　　者：刘婷[1] 李思远 张思思[3] 刘静 牛晓丽[3] 王倩茹[3] 薛荣亮[2] Liu Ting;Li Siyuan;Zhang Sisi;Liu Jing;Niu Xiaoli;Wang Qianru;Xue Rongliang(Department of Anesthesiology,Shangluo People′s Hospital,Shangluo 726000,China;Comfort Medical Center,Xi′an International Medical Central Hospital,Xi′an 710100,China;Department of Anesthesiology,The Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710004,China;Department of Outpatient,The Second Affiliated Hospital of Xi′an Medical University,Xi′an 710038,China)

机构地区：[1]商洛市中心医院麻醉科,商洛726000 [2]西安国际医学中心医院麻醉与舒适化医疗中心,西安710100 [3]西安交通大学第二附属医院麻醉科,西安710004 [4]西安医学院第二附属医院门诊部,西安710038

出　　处：《中华麻醉学杂志》2022年第6期680-684,共5页Chinese Journal of Anesthesiology

基　　金：陕西省重点研发计划(2018SF-010);西安交通大学第二附属医院人才基金项目(RCXM201907)。

摘　　要：目的评价依托咪酯与地塞米松联合用药对全麻老年患者皮质醇分泌的影响。方法选择拟在全麻下行中小型手术患者125例,年龄66~90岁,性别不限,ASA分级Ⅰ~Ⅲ级。根据随机数字表法将患者分为丙泊酚-生理盐水组(PN组,n=31)、丙泊酚-地塞米松组(PD组,n=31)、依托咪酯-生理盐水组(EN组,n=33)和依托咪酯-地塞米松组(ED组,n=30)。PN组和PD组采用丙泊酚诱导(2 mg/kg)并维持麻醉,麻醉诱导前5 min分别静脉注射生理盐水2 ml或地塞米松0.1 mg/kg;EN组和ED组采用依托咪酯诱导(0.2 mg/kg)并维持麻醉,麻醉诱导前5 min静脉注射生理盐水2 ml或地塞米松0.1 mg/kg。于手术当日晨入手术室后8:00(T_(1))、麻醉开始后1 h(T_(2))、麻醉开始后2 h(T_(3))、手术次日晨8:00(T_(4))、术后第2天晨8:00(T_(5))时采用放射免疫法测定血清皮质醇浓度。T_(1)~T_(3)时测定血糖水平,记录围麻醉期低血压发生情况、PACU期间恶心呕吐发生情况和术后24 h恶心呕吐评分。结果最终共有122例患者完成试验。与PN组比较,PD组T_(2)~T_(5)时血清皮质醇浓度降低,T_(2)和T_(3)时血糖水平升高(P<0.05),低血压、恶心、呕吐发生率和恶心呕吐评分差异无统计学意义(P>0.05),EN组T_(2)~T_(4)时血清皮质醇浓度降低,低血压发生率降低(P<0.05),血糖水平、恶心、呕吐发生率和恶心呕吐评分差异无统计学意义(P>0.05)。与ED组比较,PD组T_(2)和T_(3)时血清皮质醇浓度升高,低血压发生率升高,恶心、呕吐发生率和恶心呕吐评分降低(P<0.05),血糖水平差异无统计学意义(P>0.05),EN组T_(2)和T_(3)时血清皮质醇浓度降低,T_(4)和T_(5)时升高,T_(2)和T_(3)时血糖水平降低(P<0.05),低血压、恶心、呕吐发生率和恶心呕吐评分差异无统计学意义(P>0.05)。结论与依托咪酯或地塞米松单独使用比较,两者联合使用抑制老年患者皮质醇分泌作用的持续时间和程度显著增强。Objective To evaluate the effects of dexamethasone and etomidate on cortisol secretion in elderly patients undergoing general anesthesia.Methods One hundred and twenty-five elderly patients of either sex,aged 66-90 yr,of American Society of Anesthesiologists physical statusⅠ-Ⅲ,undergoing minor and medium elective surgeries under general anesthesia,were allocated into 4 groups using a random number table method:propofol and normal saline group(group PN,n=31),propofol and etomidate group(group PD,n=31),etomidate and normal saline group(group EN,n=33)and etomidate and dexamethasone group(group ED,n=30).In PN and EN groups,propofol(2 mg/kg)was used to induce and maintain anesthesia,and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected,respectively,at 5 min before anesthesia induction.In PD and ED groups,etomidate(0.2 mg/kg)was used to induce and maintain anesthesia,and normal saline 2 ml and dexamethasone 0.1 mg/kg were intravenously injected,respectively,at 5 min before anesthesia induction.The serum cortisol concentrations were measured at 8:00 after entering the operating room on the morning of operation(T_(1)),1 h after the start of anesthesia(T_(2)),2 h after the start of anesthesia(T_(3)),8:00 on the next day ofoperation(T_(4))and 8:00 on the 2nd day of operation(T_(5)).Blood glucose concentrations were measured at T_(1)-T_(3),and the hypotension during the peri-anesthesia period,nausea and vomiting in post-anesthesia care unit,and nausea and vomiting scores were recorded at 24 h after operation.Results A total of 122 patients completed the trial.Compared with PN group,the concentration of serum cortisol was significantly decreased at T_(2)-T_(5),blood glucose concentrations were increased at T_(2) and T_(3)(P<0.05),and no significant change was found in the incidence of hypotension,nausea and vomiting and nausea and vomiting scores in PD group(P>0.05),and the concentration of serum cortisol was significantly decreased at T_(2)-T_(4),the incidence of hypotension was decreased(P<0.05

关 键 词：依托咪酯 地塞米松 肾上腺皮质功能试验 老年人 

分 类 号：R614[医药卫生—麻醉学]