依托咪酯乳剂静脉麻醉用于高龄患者100例

Clinical observation of etomidate in intravenous anesthesia for senile patients

目的:探讨依托咪酯乳剂复合瑞芬太尼全凭静脉麻醉(TIVA)应用于高龄患者的可行性。方法:选择100例60岁以上的拟行腹部手术的高龄患者(ASA I^II级),随机分为依托咪酯组(E组,n=50)和丙泊酚组(P组,n=50),2组患者麻醉诱导一致,E组依托咪酯乳剂的维持剂量为10~15μg/(kg.min),P组丙泊酚的维持剂量为6~10 mg/(kg.h)。2组患者均复合瑞芬太尼泵注。分别于麻醉前(T0)、切皮后5 min(T1)、切皮后30 min(T2)、手术结束时(T3)、术后2 h(T4)、24 h(T5)观察心血管反应、血浆皮质醇的变化及术后苏醒的情况。结果:2组患者术中血流动力学均较稳定,但E组的波动明显低于P组;2组患者在术中、术后各时点的血浆皮质醇含量均有不同程度的降低,但均在正常范围以内;其中以手术结束时(T3)血皮质醇含量降低最明显(P<0.05),且E组的皮质醇明显低于P组(P<0.05)。术后24 h(T5)恢复至术前水平。术毕苏醒时间,P组明显短于E组(P<0.05)。结论:依托咪酯乳剂对心血管反应的影响比丙泊酚小,更适合高龄患者的全身麻醉维持;依托咪酯对肾上腺皮质的抑制作用是短暂的,可安全用于无肾上腺皮质功能减退的高龄患者的全凭静脉麻醉。

Objective： To investigate the feasibility of Etomidate emulsions combined with Remifentanil on elderly patients during total intravenous anesthesia（TIVA.） Methods： One hundred elderly patients above sixty with ASA I^II who underwent abdominal surgery were randomly divided into Etomidate group（E,n=50）and Propofol group（P,n=50）.In the two groups,all the patients received the same anesthesia induction.The patients in group E were given Etomidate 10~15 μg/（kg.min）formaintenance dose,and those in group P,Propofol6~10 mg/（kg.h）as the controls.Remifentanil was combined during the surgery in both groups.There were observed and recorded for cardiovascular effects,blood plsma cortisol changes and postoperative analepsia condition before anesthesia,5 min and 30 min after incising the skin,0 h,2 h and 24 h after operation.Results： The stable hemodynamics in both groups could be maintained perioperatively,but the fluctuation was significantly lower in group E than those in group P.The content of blood plasma cortisol in both groups alldecreased with in normal limits among intraoperative and postoperative time points.Compared with group P,the content of cortisol was lower in group E（P0.05）,though the cortisol in both groups alldecreased obviously at operation end.The cortisol recovered to the preoperative level 24 h after operation.Recovery time after operation of group P was shorter than that of group E（P0.05）.Con-clusion： Etomidate emulsions is more suitable for elderly patients during the maintenance of genenal anesthesia with less cardiovascular effects than Propofol.It is safe to use Etomidate on elderlypatients without adrenal cortex hypofunction during TIVA as the inhibitory action of Etomidate on adrenal cortex is short-lived.