艾司氯胺酮、舒芬太尼和咪达唑仑预防麻醉诱导期依托咪酯诱发肌阵挛的比较  

Comparison of esketamine,sufentanil,and midazolamin in preventing etomidate-induced myoclonus during anesthesia induction

作　　者：邸立超 张贺 张馥镇 黄立宁[1] DI Lichao;ZHANG He;ZHANG Fuzhen;HUANG Lining(Department of Anesthesiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《临床麻醉学杂志》2025年第4期386-390,共5页Journal of Clinical Anesthesiology

摘　　要：目的比较小剂量舒芬太尼、咪达唑仑和艾司氯胺酮预处理对麻醉诱导期依托咪酯致肌阵挛的影响。方法选择择期全麻手术患者150例,男61例,女89例,年龄18~60岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为三组:舒芬太尼组(F组)、咪达唑仑组(M组)和艾司氯胺酮组(S组),每组50例。F组麻醉诱导前静注舒芬太尼0.1μg/kg,M组静注咪达唑仑30μg/kg,S组静注艾司氯胺酮0.2 mg/kg。90 s后静注依托咪酯0.3 mg/kg,注射时间30 s。记录静注依托咪酯后1 min内肌阵挛发生情况,评价其程度和肌阵挛发生时间。记录给药前至静注依托咪酯后1 min内,心动过速、心动过缓、高血压、低血压、呼吸抑制、烦躁、幻觉、恶心呕吐等不良反应的发生情况。结果F组发生肌阵挛4例(8%),发生轻度和中度肌阵挛分别为3例(6%)和1例(2%)。M组肌阵挛发生率14例(28%),发生轻度、中度和重度肌阵挛分别为3例(6%)、10例(20%)和1例(2%)。S组肌阵挛发生率为18例(36%),发生中度和重度肌阵挛分别为4例(8%)和14例(28%)。与S组比较,F组和M组重度程度肌阵挛发生率明显降低(P<0.05)。与M组比较,F组中度程度肌阵挛发生率明显降低(P<0.05)。与S组比较,F组肌阵挛总发生率明显降低(P<0.05)。与M组比较,F组肌阵挛总发生率明显降低(P<0.05)。与S组比较,F组和M组肌阵挛发生时间明显延长(P<0.05)。M组和F组肌阵挛发生时间差异无统计学意义。三组心动过速发生率差异无统计学意义。三组无一例心动过缓、高血压、低血压、呼吸抑制、烦躁、幻觉、恶心呕吐等不良反应发生。结论舒芬太尼可有效预防麻醉诱导时依托咪酯诱发的肌阵挛,优于咪达唑仑和艾司氯胺酮。Objective To compare the effect of low-dose sufentanil,midazolam and esketamine pretreatment on etomidate-induced myoclonus during induction of general anesthesia.Methods A total of 150 patients,61 males and 89 females,aged 18-60 years,BMI 18.5-30.0 kg/m^(2),ASA physical statusⅠorⅡ,who underwent elective general anesthesia surgery were selected.The patients were randomly divided into three groups:sufentanil group(group F),midazolam group(group M),and esketamine group(group S),50 patients in each group.Patients in group F received intravenous administration of sufentanil 0.1μg/kg before anesthesia induction,patients in group M received intravenous administration of midazolam 30μg/kg,while patients in group S received intravenous administration esketamine of 0.2 mg/kg.After 90 seconds patients received intravenous administration etomidate 0.3 mg/kg.The injection time was 30 seconds.The incidence of myoclonus and the severity of myoclonus,and the time of the occurrence of myoclonus were recorded within 1 minute after intravenous administration of etomidate.Record the occurrence of adverse reactions,including tachycardia,bradycardia,hypertension,hypotension,respiratory depression,irritability,hallucinations,nausea,and vomiting,from before administration to 1 minute after the intravenous injection of etomidate.Results The incidence of myoclonus in group F was 4 patients(8%),with mild and moderate myoclonus occurring at 3 patients(6%)and 1 patient(2%),respectively.The incidence of myoclonus in group M was 14 patients(28%),with mild,moderate,and severe myoclonus occurring at 3 patients(6%),10 patients(20%),and 1 patient(2%),respectively.The incidence of myoclonus in group S was 18 patients(36%),with moderate and severe muscle myoclonus occurring at 4 patients(8%)and 14 patients(28%),respectively.Compared with group S,the incidence of severe myoclonus in group F and group M were significantly reduced(P<0.05).Compared with group M,the incidence of moderate myoclonus in group F was significantly reduced(P<0.05).Compa

关 键 词：舒芬太尼 咪达唑仑 艾司氯胺酮 依托咪酯 肌阵挛 

分 类 号：R614[医药卫生—麻醉学]