依托咪酯与普鲁泊福在困难气管纤维支气管镜引导插管时安全性比较

Comparison of the safety between etomidate and propofol for fibreoptic intubation for difficult intubation

目的比较依托咪酯与普鲁泊福全麻诱导在困难气管纤维支气管镜（纤支镜）引导插管时的安全性。方法选择困难气管患者34例，随机分成E组和P组，每组各17例。利多卡因行鼻至气管表面麻醉，静脉推注芬太尼和依托咪酯（E组）或普鲁泊福（P组），意识消失后在纤支镜引导下经鼻气管插管，插管成功后查动脉血气。监测脑电双频指数（BIS）和呼气末二氧化碳分压（PETCO2）。记录患者意识消失时间、自主呼吸恢复时间、BIS、达到最低BIS时间及动脉血气、乳酸和PETCO2。结果两组皆完成气管插管，意识消失时间、BIS、乳酸及PETCO2比较差异均无统计学意义，E组自主呼吸恢复时间及达到最低BIS时间[（48．3±10．7）、（36．7±9．3）s]显著短于P组[（98．7±11．3）、（68．5±12．1）s]（P〈0．01）。结论困难气管纤支镜引导插管时使用依托咪酯诱导，自主呼吸恢复时间显著快于使用普鲁泊福，故使用依托咪酯比普鲁泊福更安全。

Objective To compare the safety between etomidate and propofol for fibreoptic intubation for difficult intubation during induction of anesthesia. Methods Thirty-four ASA Ⅰ - Ⅱpatients were randomly divided into group E and group P, each group was 17 cases. During induction, etomidate and fentanyl were used in group E and propofol was used in group P. All patients were administered lidocaine for superficial anesthesia from nasal cavity to upper trachea. Intravenous injection of fentanyl and administered etomidate or propofol, all patients were intubated with fibreoptic after loss of consciousness. Lactic acid （LAC）, bispectral index of cerebral （BIS）, end-tidal carbon dioxide partial pressure （PETCO2） were monitored and time to loss of consciousness, time to recovery of spontaneous breathing, BIS value, time of the lowest BIS value, LAC value and （PETCO2） value were measured. Results All patients were successfully achieved fibreoptic intubation. The time to loss of consciousness, BIS value, LAC value and end-tidal carbon dioride partial pressure PETCO2 value were no significant difference between two groups. The time to recovery of spontaneous breathing and the time of the lowest BIS values were significant difference between two groups [（48.3±10.7） s, （36.7±9.3）svs （98.7±11.3） s, （68.5±12.1）s]（P〈0.01）. Conclusion For fibreoptic intubation for difficult intubation, the time to recovery of spontaneous breathing of using etomidate for induction is faster than using propofol, so etomidate is considered more safe.