依托咪酯复合芬太尼及氯胺酮在乳腺和四肢等浅表手术中的应用

Use of Etomidate and compound Fentanyl combined with Ketamine in superficial operations on the breast or soft tissues of extremities

目的：探讨依托咪酯乳剂复合芬太尼、氯胺酮在全凭静脉麻醉中应用的可行性.方法：选择80例阿司匹林Ⅰ～Ⅱ级,拟行乳腺、四肢等浅表手术患者,随机分为依托咪酯组（E组,40例）和丙泊酚组（B组,40例）.在术者铺巾时E组依次静脉注射依托咪酯孔剂0.2 mg/kg,氯胺酮1 mg/kg,注药时间15～30 s;B组依次静脉注射丙泊酚1 mg/kg,氯胺酮1 mg/kg,注药时间45～60 s,待患者睫毛反射消失后开始手术,E组的麻醉维持用依托咪酯乳剂40 mg,芬太尼0.2 mg,氯胺酮200 mg加入500 mL 0.9%盐水中静脉滴注;B组的麻醉维持用丙泊酚400 mg,芬太尼0.2 mg,氯胺酮200 mg加入500 mL 0.9%盐水中静脉滴注.术中两组均视患者反应及手术情况调整滴速.在手术结束前20～30 min停止用药.术中连续监测心电图（ECG）,平均气道压（MAP）,心率（HR）及动脉血氧饮和度（SpO2）,必要时使用鼻咽通气道或辅助呼吸.记录两组麻醉效果,不同时期的MAP,HR,SpO2,依托味酯乳剂与异丙酚用量,睫毛反射消失时间,苏醒时间,麻醉恢复室停留时间,术中术后不良反应.结果：两组患者术中血流动力学均维持稳定,两组麻醉效果,睫毛反射消失时间、苏醒时间、麻醉恢复室停留时间差异无统计学意义（P〉0.05）.结论：依托咪酯乳剂与丙泊酚复合芬太尼、氯胺酮麻醉均可快速、安全、有效地用于乳腺、四肢等浅表手术,但依托咪酯乳剂更经济.

Objective：To evaluate the efficacy of Etomidate and compound Fentanyl combined with Ketamine in superficial operations on the breast or soft tissues of extremities. Methods：80 Grades ASA Ⅰ - Ⅱ patients who underwent superficial operations on the breast or extremity soft tissue were randomized into two groups： etomidate group （group E, n = 40） and propofol group （group B, n = 40）. During draping prior to the procedures, the patients in group E received injection of 0.2 mg/kg Etomide and 1 mg/kg Ketamine within 15 to 30 seconds ,while those in group B were injected with 1 mg/kg propofol and 1 mg/kg ketamine within 45 to 60 seconds. After abolition of eyelash reflex, operations were performed with maintaince anesthesia by intravenous infusion of 40 mg etomidate ,0.2 mg fentanyl and 200 mg ketamine in 500 mL of 0. 9% saline for group E, and by intravenous infusion of 400 mg propofol,0.2 mg fentanyl and 200 mg ketamine in 500 mL of 0.9% saline for group B. The rate of infusion was adjusted according to the reactions and situations at operation in the two groups of patients. Anesthesia was discontinued at 20 to 30 mins before the end of operations. EGG, MAP, HR and SpO2 were continuously monitored during the operation. Nasal tubes or mechanical ventilation was used if needed. The efficiency of anesthesia, values of MAP, HR and SpO2 at various time spots, use of Etomidate and Propofol, time to abolition of eyelash reflex, time of awakening, length of stay at recovery room, side effects after operation were compared between the two groups.Results：The hemodynamic data were comparable in the two groups. No significant differences were found in efficiency of anesthesia, time to abolition of eyelash reflex, awakening time and length of stay at recovery room were found between two groups （ P 〉 0.05 ）. Conclusion： Etomidate and Compound Fentanyl combined with Ketamine may be safe, fast-acting and effective for anesthesia in patients undergoing superfical operations on breast or soft tissue of extremities. Etomidate emulsion can be more cost-effective.