依托咪酯麻醉诱导期对血流动力学及不同给药顺序对肌阵挛的影响

Hemodynamic Changes in the Induction of Anesthesia with Etomidate and the Effect of the Sequence of Drug Administraion on Myoclonus

目的观察乳剂依托咪酯麻醉诱导期血流动力学的变化及不同给药顺序对肌阵挛的影响。方法非高血压组455例,高血压组204例。开通静脉后平静15min测得平均压和心率为基础值(T0),麻醉诱导用咪达唑仑、依托咪酯、芬太尼、顺式阿曲库铵静脉注射,记录患者睫毛反射消失时(T1),注射依托咪酯后3min(T2)和5min(T3)上述参数,气管插管吸入七氟烷,插管后1min(T4)和5min(T5)记录上述参数。根据给药顺序不同又分为A、B和C组,A组先注射依托咪酯后咪达唑仑、芬太尼和顺式阿曲库铵,B组麻醉诱导先注射咪达唑仑后依托咪酯、芬太尼和顺式阿曲库铵,C组先注射芬太尼后注射依托咪酯、咪达唑仑和顺式阿曲库铵,观察肌阵挛发生率及程度。结果高血压组患者在静注依托咪酯后血压和心率下降明显(P<0.05),非高血压组心率下降明显(P<0.05)。芬太尼或咪达唑仑可明显减少肌阵挛的发生率和强度。结论依托咪酯0.3mg/kg麻醉诱导对高血压患者可导致明显的血压和心率下降,预先给予芬太尼或咪达唑仑可明显减少肌阵挛的发生率和强度。

Objective To assess hemodynamic changes in the induction of anesthesia with etomidate and the effect of the sequence of drug administraion on myoclonus.Methods In this study,455 patients without hypertension and 204 patients with hypertension were included.The baseline mean arterial pressure（MAP）and heart rate（HR）were recorded 15 minutes after venous channel was unclamped（T0）.Midazolam,etomidate,fentanyl,and cisatracurium were injected intravenously to facilitate tracheal intubation.MAP and HR were recorded when the eyelash reflex disappeared（T1）and 3（T2）and 5 minutes（T3）after the injection of etomidate.After tracheal intubation sevoflurane was used for the maintenance of anesthesia.MAP and HR were recorded 1（T4）and 5 minutes（T5）after intubation.According to the sequences of drug administration during induction,the patients were randomly assigned to receive etomidate,midazolam,fentanyl,and cisatracurium in turn in group A,midazolam,etomiate,fentanyl,and cisatracurium in group B,and fentanyl,etomiate,midazolam,and cisatracurium in group C.The incidence and severity of myoclonus were observed.Results After the injection of etomiate,MAP and HR in patients with hypertension and HR in those without hypertension significantly decreased（P 〈 0.05）.Fentanyl and midazolam decreased the incidence and severity of myoclonus.Conclusion Etomidate at a dose of 0.3 mg/kg could derease MPA and HR in patients with hypertension,and pretreatment with fentanyl or midazolam may decrease the incidence and severity of myoclonus.