依托咪酯与咪达唑仑对非体外循环冠脉搭桥手术气管插管期间血流动力学的影响比较

Comparision of Etominate and Midazolam on Blood Flow Dynamics during Tracheal Intubation in off Pump Coronary Artery Bypass Graft

目的比较依托咪酯与咪达唑仑对非体外循环冠状动脉搭桥手术气管插管期间血流动力学的影响。方法非体外循环冠状动脉搭桥手术患者60例,随机分为依托咪酯组(E组)和咪达唑仑组(M组)各30例。麻醉诱导用药:E组给予依托咪酯0.3 mg.kg-1,舒芬太尼1.0μg.k-g1、罗库溴铵0.9 mg.kg-1;M组给予咪达唑仑0.15mg.kg-1、舒芬尼1.0μg.kg-1、罗库溴铵0.9 mg.kg-1。在麻醉期间连续监测和记录心电图(ECG)、收缩压(SBP)、舒张压(DBP)、心率(HR)及脉搏血氧饱和度(SpO2)的变化,并计算心率和收缩压乘积(RPP)。记录气管插管时间。结果M组麻醉诱导后气管插管开始时SBP、DBP均较气管插管前明显下降(P<0.05),气管插管后1 m in SBP、DBP、RPP和HR均较气管插管开始时显著升高(P<0.01),且插管后1 m in RPP比气管插管前明显升高(P<0.01)。与E组对应值比较,气管插管开始时M组SBP、DBP显著降低(P<0.05或0.01),而气管插管后1 m inM组SBP、DBP和RPP均显著升高(P<0.05或P<0.01)。结论与咪达唑仑相比,非体外循环冠脉搭桥手术患者麻醉诱导时使用依托咪酯可更有效抑制气管插管时的心血管反应。

Objective To compare the effect of etominate and midazolam on blood flow dynamics during tracheal intubation in off pump coronary artery bypass graft. Methods Sixty patients scheduled for coronary artery bypass graft surgery without cardiopulmonary bypass shunt were randomly divided into etominate group （Group E, n = 30） and midazolam group （Group M, n = 30）. The drugs used for anaesthetic induction in Group E were etominate 0.3 mg·kg^-1, sulfentanyl 1.0 μg·kg^-1, rocuronium bromide 0.9 mg·kg^-1, and in Group M midazolam 0.15 mg·kg^-1, sulfentanyl 1.0 μg·kg^-1, rocuronium bromide 0.9 mg·kg^-1. Electrocardiagram （ECG）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and pulse oximetry saturation （SpO2） were measured and recorded continuously, as well as the value of SBP multiplied by HR （RPP）. The time used for tracheal intubation was also recorded. Results In Group M, the SBP and DBP were significantly lower from anaesthetic induction and the beginning of tracheal intubation than the values before putting in the tracheal tube （P 〈 0.05）, the SBP, DBP and HR were significantly higher after 1 minute of tracheal intubation than the values at the beginning of tracheal intubation （P 〈 0.01）, and the values of RPP after tracheal intubation were significantly different from the values before putting in the tracheal tube （P 〈 0.01）. Compared with the values in Group E, the values of SBP or DBP in Group M were significantly decreased when tracheal tube was ready to be put in （P 〈 0.05 or P 〈0.01）, while the values of SBP, DBP or RPP were significantly increased 1 minute after tracheal intubation （P 〈 0.05 or 0.01）. Conclusion Compared with midazolam, etominate used in anaesthetic induction for coronary artery bypass graft surgery without cardiopulmonary bypass shunt may more effectively prevent the cardiovascular response to tracheal intubation.