小剂量依托咪酯联合丙泊酚对全麻诱导效果的影响

Efficacy of low-dose etomidate combined with propofol for general anesthesia induction

目的探讨小剂量依托咪酯联合丙泊酚用于全麻诱导对血流动力学、麻醉深度的影响并观察其不良反应。方法选择2018-10至2020-12解放军总医院第一医学中心择期行全麻手术患者90例,随机分为丙泊酚(A组)、依托咪酯(B组)、依托咪酯联合丙泊酚组(C组),每组30例。A组静脉注射丙泊酚2.0 mg/kg,B组静脉注射依托咪酯0.3 mg/kg,C组静脉注射依托咪酯0.075 mg/kg、丙泊酚1.0 mg/kg。诱导完成后行气管插管,观察记录诱导前(T_(0))、插管前(T_(1))、插管后1、3、5 min(T_(2)-T_(4))3组患者平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)及脑电双频指数(bispectral index,BIS)的变化,记录3组患者注射痛、肌阵挛、高血压、低血压、BIS<30等不良反应发生率。结果C组诱导后的MAP高于A组(P<0.05),C组在T_(1-4)时刻MAP高于A组,T_(2)时刻MAP低于B组(P<0.05),且诱导后HR低于B组,T_(2)时刻HR低于B组(P<0.05),BIS低于A组,T_(1)时刻BIS高于B组,T_(2-3)时刻低于A组,T_(4)时刻低于A组,高于B组(P<0.05),注射痛和低血压发生率低于A组(0.0%vs.36.7%,3.3%vs.33.3%),肌阵挛发生率低于B组(3.3%vs.66.7%),高血压、BIS<30发生率低于A、B组(3.3%vs.40.0%、70.0%,0.0%vs.30.0%、60.0%),差异均有统计学意义(P<0.05)。结论预注射依托咪酯进行麻醉诱导,于插管前注射丙泊酚对全麻的血流动力学和麻醉深度影响小,不良反应发生率低。

Objective To investigate the effects of low-dose etomidate combined with propofol as a means of general anesthesia induction and observe the changes of hemodynamics,the depth of anesthesia and adverse reactions.Methods Ninety patients scheduled for general anesthesia in our hospital between October 2018 and February 2020 were enrolled.These patients were randomly divided into three groups,with 30 patients in each.The methods of anesthesia induction included propofol 2.0 mg/kg in group A,etomidate 0.3 mg/kg in group B,and etomidate 0.075 mg/kg+propofol 1.0 mg/kg in group C.MAP,HR,BIS were measured respectively before induction(T_(0)),before intubation(T_(1)),and 1,3 and 5 minutes(T_(2-4))after intubation.Such adverse reactions as injection pain,myoclonus,hypertension,hypotension,and BIS<30 in each group were recorded.Results MAP in group C was higher than in group A at T_(1-4),but was lower than in group B at T_(2)(P<0.05).HR was lower in group C than in group B at T_(2)(P<0.05),BIS in group C was lower than in group A at T_(2-4),but was higher than in group B at T_(2)and T_(4)(P<0.05).The incidence of injection pain and hypotension was lower in group C than in group A(0.0%vs.36.7%,3.3%vs.33.3%,P<0.05),so was the incidence of myoclonus(3.3%vs.66.7%,P<0.05).The incidence of hypertension and BIS<30 was lower in group C than in group A and B(3.3%vs.40.0%、70.0%,0.0%vs.30.0%、60.0%,P<0.05).Conclusions After injection of etomidate for general anesthesia induction,propofol injected prior to tracheal intubation is a better agent for general anesthesia induction as evidenced by the stability of hemodynamics and the depth of anesthesia as well as lower incidence of adverse reactions.