依托咪酯用于不同年龄患者静脉麻醉的临床研究

The clinical study on intravenous anesthesia effects of etomidate in different ages group

目的观察和比较依托咪酯用于不同年龄患者静脉麻醉时的苏醒时间、血流动力学的变化及不良反应。方法选择3个月至12岁患儿113例,24～55岁妇科患者38例,按年龄分为4组:3个月至1岁为婴儿组,1～3岁为幼儿组,3～12岁为儿童组,24～55岁为成人组。各组依次给予咪唑安定0.1mg/kg体质量(插管前5min静脉推注),芬太尼3μg/kg体质量(插管前3min静脉推注),顺阿曲库胺0.15mg/kg体质量(插管前3min静脉推注),依托咪酯0.3mg/kg体质量(插管前0.5min静脉推注)全身麻醉诱导,麻醉维持:插管后即开始依托咪酯8～30μg·kg-1·min-1微量泵持续静注,瑞芬太尼6～60μg·kg-·1h-1,按需给予顺阿曲库胺。观察年龄组患者术前访视(T0)、入室后(T1)、诱导后(T2)、插管后(T3)、术中30min(T4)和拔管后(T5)的收缩压、舒张压、心率的变化及各组苏醒时间,拔管时间及24h内可能的出现的不良反应。结果在4个年龄组中,婴儿组与儿童组、成人组比较,清醒时间、拔管时间的差异有统计学意义(P<0.01),其余年龄组之间均无统计学意义。在婴儿、幼儿和儿童组,与T0比较,T1、T3、T5时点的血压、心率波动差别有统计学意义(P<0.01)。在成人组,与T0比较,T2、T5时点的血压、心率波动有统计学意义(P<0.01)。结论依托咪酯可安全用于不同年龄患者麻醉。

Objective To compare the effects on awaken time,hemodynamics changes and adverse reaction induced by etomidate in different ages group.Methods One hundred and fifty-one patients including 113 children（aged from 3 months to 12 years old）and 38 adult patients with gynecology（aged from 24 to 55 year old）were divided into four groups：infants group（3 month to 1 year）,pediatric group（1～3 year）,children group（3～12 year）,adult group（24～55 year）.For each group,in the course of induction of general anesthesia,midazolam（0.1 mg/kg,5 minutes before intubation）,fentanyl（3 μg/kg,3 minutes before intubation）,cisatracurium besilate（0.15 mg/kg,3 minutes before intubation）,etomidate（0.3 mg/kg,0.5 minutes before intubation）were used by intravenous injection,and in the course of maintenance of anesthesia,etomidate was infused with an infusion pump（8～30 μg·kg^-1·min^-1）combined with remifen-tanil infusion（6～60 μg·kg^-1·h^-1）to maintain anaesthesia.Cisatracurium besilate was used according to requirement.The contractive pressure,diastolic pressure,heart rate changes and awaken time in different time point（T0：preoperative visits,T1：admitting operation room at once,T2：after induction,T3：after intubation,T4：30 minutes after operating initiating,T3：after extubating）of each group and extubation time,adverse reaction rate 24 hours after operating were observed,respec-tively.Results The differences for awaken time and extubation time between infants group,children group and adult group were statistically significant（P〈0.01）,and no significant difference was found between other groups.In infants,pediatric and children groups,blood pressure and heart rate changes on T1,T3 and T5 were significantly different from that on T0（P〈0.01）.In adult group,blood pressure and heart rate changes on T2 and T5 were significantly different from T0（P 〈0.01）.Conclusion Etomidate can be used safely to patients of different gaes for pediatric anesthesia.