医学研究与教育 ›› 2015, Vol. 32 ›› Issue (3): 56-60.DOI: 10.3969/j.issn.1674-490X.2015.03.013

• 临床研究 • 上一篇    下一篇

依托咪酯在短时神经外科手术麻醉中的应用

任峰1,刘彬2,吕林1,陆新来1   

  1. 1. 安国市医院麻醉科,河北 保定 071200;2. 北京煤炭总医院麻醉科,北京 朝阳 100028
  • 出版日期:2015-06-25 发布日期:2015-06-25
  • 作者简介:任峰(1981—),男,河北安国人,主治医师,硕士,主要从事临床麻醉与疼痛诊疗。E-mail: renfeng0018@163.com

Application of etomidate anesthesia in short-time neurosurgery operation

REN Feng1, LIU Bin2, LYU Lin1, LU Xinlai1   

  1. 1. Department of Anesthesiology, Anguo City Hospital, Baoding 071200, China; 2. Department of Anesthesiology, Beijing Coal General Hospital, Beijing 100028, China
  • Online:2015-06-25 Published:2015-06-25

摘要: 目的 观察和比较依托咪酯与丙泊酚应用于短时间神经外科患者全麻诱导和维持时血流动力学的变化和不良反应发生的情况。 方法 选择择期神经外科手术患者 50 例,手术时间限定 2~3 h,随机分为依托咪酯组(E 组, n=25)和丙泊酚组(P 组, n=25)。患者入室开放静脉后先给予咪唑安定 0.03 mg/kg,全麻诱导均采用舒芬太尼 0.3 μg/kg,罗库溴铵0.6 mg/kg;P 组用丙泊酚 2.0 mg/kg,E 组用依托咪酯 0.3 mg/kg 完成诱导后气管插管。记录患者在基础状态(T0)、插管前时刻(T1)、插管后即刻(T2)及插管后 1 min(T3)、3 min(T4)、5 min(T5)、10 min(T6)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、血氧饱和度(SpO2)和心率(HR),记录 2 组患者在麻醉维持过程中血管活性药物的应用情况,记录 2 组患者术中的出入量,记录 2 组患者在手术结束时苏醒时间和拔管时间以及患者围术期发生肌颤、恶 心、呕吐、注射痛等不良反应的发生情况。 结果(1)2 组患者术中液体出入量、手术时间、麻醉时间、术毕后清醒时间以及拔管时间等比较差异均无统计学意义。(2)与入室时相比,P 组在 3、5、10 min SBP、DBP 明显降低(P<0.05 或P<0.05);P 组在插管后 1 min HR 明显增快(P<0.05),插管后 3、5、10 min 时减慢(P<0.05);E 组插管后 1、3 min HR明显增快(P<0.05 或 P<0.05)。(3)诱导期间 2 组患者最高 HR、SBP 和最低 SBP、HR 的比较差异均无统计学意义;2 组患者术中应用血管活性药物的情况分别是 E 组为 4%,而 P 组为 16%,2 者间差异有统计学意义(P<0.05)。(4)E 组患者注射痛的发生率显著低于 P 组(P<0.05)。 结论 依托咪酯乳剂可安全应用于短时神经外科手术麻醉诱导与术中麻醉维持;与丙泊酚比较,依托咪酯诱导和维持对血流动力学影响轻微,但术后苏醒期躁动、恶心、呕吐的发生率较高。

关键词: 全身麻醉, 依托咪酯, 丙泊酚, 神经外科

Abstract: Objective To investigate and compare the changes of hemodynamic and the occurrence of adverse reaction of etomidate and propofol used in short time neurosurgery.Methods 50 patients undergone elective neurosurgery, whose operation time was limited to 2-3 hours, were randomly divided into etomidate group (group E, n=25) and propofol group (group P, n=25). Induction with sufentanil 0.3 μg/kg, rocuronium 0.6 mg/kg, group P with propofol 2.0 mg/kg, group E with etomidate 0.3 mg/kg. Recording the basal state (T0), beforeintubation moment (T1), after intubation (T2) and 1 min after intubation (T3), 3 min (T4), 5 min (T5), 10 min (T6), systolic blood pressure(SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SpO2) and heart rate (HR), recording the application of vasoactive drugs, intake and output, the recovery time and extubation time and the incidence of adverse reactions were recorded. Results (1) The fluid volume, operation time, anesthesia time, postoperative recovery time after extubation were not difference in patients in the two groups. (2) In group P, in T4, T5, T6, SBP, DBP decreased significantly (P<0.05 or P<0.01). In T3 HR increased obviously (P<0.05), in T4, T5, T6, decreased (P<0.05). In group E T3, T4, HR increased significantly (P<0.05 or P<0.01). (3) The highest HR, the highest SBP and the lowest SBP, were of no statistical significance, application of vasoactive drugs in patients in the two group were 4% in group E, and 16% in group P, the difference was statistically significant (P<0.01). (4) Injection pain was significantly lower in the group E than that in group P(P<0.01). Conclusion Etomidate can be safely applied in short-time neurosurgery operation. Compared with propofol, etomidate has less influence on hemodynamic in induction and maintenance, but the postoperative restlessness, nausea, vomiting were higher.

Key words: general anesthesia, Etomidate, Propofol, neurosurgery

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