丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响  

Effects of propofol versus etomidate on laryngoscopic tracheal intubation conditions and stress response in elderly patients taking general anesthesia

作　　者：何花丽 朱明霞 赵一凡 单兆亚 He Huali;Zhu Mingxia;Zhao Yifan;Shan Zhaoya(Department of Operation and Anesthesiology,Hospital Affiliated to Shaanxi University of Chinese Medicine,Xianyang 712000,China;Department of Operation and Anesthesiology,Xi'an Fourth Hospital,Xi'an 710000,China)

机构地区：[1]陕西中医药大学附属医院手术麻醉科,咸阳712000 [2]西安市第四医院手术麻醉科,西安710000

出　　处：《国际医药卫生导报》2024年第5期802-808,共7页International Medicine and Health Guidance News

摘　　要：目的比较丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响。方法选取陕西中医药大学附属医院2022年6月至2023年8月收治的130例择期行骨科全麻手术老年患者进行随机对照试验,采用随机数字表法将其分为丙泊酚组(P组)与依托咪酯组(E组),各65例。P组麻醉诱导给予2.0 mg/kg丙泊酚,E组麻醉诱导给予0.3 mg/kg依托咪酯,分别联合舒芬太尼0.50μg/kg、顺阿曲库铵0.15 mg/kg。插管完毕后立即采用Viby-Mogensen插管条件量表评价插管条件;记录麻醉诱导前(T_(0))、丙泊酚/依托咪酯注射即刻(T_(1))、喉镜置入后(T_(2))、气管插管后1 min(T_(3))、气管插管成功3 min(T_(4))平均动脉压(MAP)、心率(HR)及心率压力乘积(RPP);比较T_(0)、T_(2)、T_(4)时去甲肾上腺素(NE)、皮质醇(Cor)及血糖水平;比较两组丙泊酚或依托咪酯注射30 s内注射痛发生率、严重程度;比较两组气管插管时间。采用χ^(2)检验、Mann-Whitney U检验、重复测量方差分析、t检验。结果两组患者年龄、性别、体质量指数、ASA分级等基线资料比较,差异均无统计学意义(均P>0.05)。两组患者Viby-Mogensen插管条件量表的置入喉镜、声带位置、声带运动、气道反应及肢体反应分级比较,差异均无统计学意义(均P>0.05)。T_(2)、T_(3)、T_(4)时,E组MAP均高于P组,HR均低于P组,差异均有统计学意义(均P<0.05)。E组T_(2)时NE[(135.32±30.47)μg/L比(147.54±32.16)μg/L]、Cor[(68.39±14.12)ng/L比(76.17±14.65)ng/L]及血糖[(5.46±0.64)mmol/L比(6.04±0.76)mmol/L]均低于P组,差异均有统计学意义(均P<0.05);E组T_(3)时NE[(154.69±33.42)μg/L比(170.35±36.30)μg/L]、Cor[(73.42±14.59)ng/L比(82.64±16.73)ng/L]及血糖[(6.72±0.95)mmol/L比(8.29±1.03)mmol/L]均低于P组,差异均有统计学意义(均P<0.05)。两组气管插管时间比较,差异无统计学意义(P>0.05)。E组注射痛发生率、注射痛得分均低于P组[17.46%(11/63)比56.67%(34/60)�Objective To explore the effects of propofol versus etomidate on laryngoscopic tracheal intubation conditions and stress response in elderly patients taking general anesthesia.Methods One hundred and thirty elderly patients who underwent elective orthopedic surgery under general anesthesia at Hospital Affiliated to Shaanxi University of Chinese Medicine from June 2022 to August 2023 were selected for the randomized controlled trial.They were divided into a propofol group(group P)and an etomidate group(group E)by the random number table method,with 65 cases in each group.Group P took anesthesia induction by 2.0 mg/kg propofol,and group E by 0.3 mg/kg etomidate;both groups combined with 0.50μg/kg sufentanil and 0.15 mg/kg cisatracurium.The intubation conditions were evaluated by the Viby-Mogensen Intubation Conditions Scale immediately after intubation.The meal artery pressure(MAP),heart rate(HR),and rate pressure product(RPP)were recorded before anesthesia induction(T_(0)),immediately after propofol/etomidate injection(T_(1)),after laryngoscope insertion(T_(2)),1 min after tracheal intubation(T_(3)),and 3 min after successful tracheal intubation(T_(4)).The levels of norepinephrine(NE),cortisol(Cor),and blood glucose were compared at T_(0),T_(2),and T_(4).The incidences and severities of injection pain within 30 s after propofol or etomidate injection were compared between the two groups.The tracheal intubation times were compared between the two groups.Theχ^(2)test,Mann-Whitney U test,tepeated measurement ANOVA,and t test were used.Results There were no statistical differences in the basal line data,such as age,gender,body mass index,American Society of Anesthesiology(ASA)grading,etc.,between the two groups(all P>0.05).There were no statistical differences in the laryngoscope insertion,vocal cord position,vocal cord movement,airway response,and limb response of the Viby-Mogensen Intubation Conditions Scale between the two groups(all P>0.05).The MAP's at T_(2),T_(3),and T_(4)in group E were higher than those in g

关 键 词：丙泊酚 依托咪酯 老年全麻手术 可视喉镜 气管插管 应激反应 

分 类 号：R614.2[医药卫生—麻醉学]