8%七氟醚和依托咪酯用于全身麻醉的诱导比较

Comparison of 8% Sevoflurane and Etomidate during induction of general anesthesia

目的比较8%七氟醚和依托咪酯在全身麻醉诱导中对血流动力学的影响及不良反应的发生率。方法选择ASAⅠ～Ⅱ级择期手术50例,随机分为两组:Ⅰ组为七氟醚组、吸入8%七氟醚;Ⅱ组为依托咪酯组、静脉注射依托咪酯脂肪乳注射剂0.3 mg/kg。两组待睫毛反射消失后静脉注射咪唑安定0.1 mg/kg、芬太尼3μg/kg、维库溴铵0.l mg/kg。观察诱导期不同时段诱导前(T0)、睫毛反射消失时(T1)、全身麻醉药后2 min(T2)、插管后1 min(T3)、插管后3 min(T4)、插管后5 min(T5)、插管后10 min(T6)的血压、心率、脉搏血氧饱和度的变化,记录诱导期两组不良反应的发生率及术后对麻醉满意度的相关反馈。结果两组病人睫毛反射消失时间比较差异有显著性(P<0.05),Ⅰ组慢于Ⅱ组。Ⅰ组与Ⅱ组比较,其体动、肌颤发生率低(P<0.05);Ⅰ组患者闻及异样气味与Ⅱ组比较差异有显著性(P<0.05);两组患者对麻醉满意度均高。Ⅰ组与Ⅱ组的SBP在T2、T4、T5、T6时段对比差异有显著性,DBP与MAP在T2、T3、T4、T5、T6时段两组比较差异有显著性;两组血压在诱导后均有下降趋势。HR在各时段点两组比较,均无统计学差异;气管插管后两组HR均回升,后又逐渐下降。两组SPO2在T4、T5、T6对比差异有显著性,但SPO2均大于99%,无临床意义。结论 8%七氟醚诱导速度慢于依托咪酯,但无临床意义;其不良反应低,临床应用中患者满意度高。与依托咪酯麻醉诱导相比,8%七氟醚麻醉诱导对血流动力学影响明显,因此对血流动力学不稳定及老年患者,应用该浓度诱导时应注意维持其血流动力学的稳定,或应用低浓度七氟醚诱导。

【Objective】 To compare hemodynamics and the incidence of adverse reactions during induction of 8% sevofluane and Etomidate.【Methods】 50 ASA Ⅰ or Ⅱ Grade patients undergoing elective surgery were randomly divided into two groups： group Ⅰ（Sevoflurane group）,inhalation of 8% Sevoflurane;group Ⅱ（Etomidate group）,intravenous injection of Etomidate fat emulsion injection 0.3 mg/kg.After loss of eyelash reflex,the two groups of patients with intravenous injection of midazolam 0.1mg/kg,fentanyl 3 ug/kg,vecuronium 0.l mg/kg.The blood pressure and heart rate and pulse oxygen saturation changes of two groups were observed before induction（T0）,when loss of eyelash reflex（T1）,2 minutes after anesthesia（T2）,after intubation 1 min（T3）,after intubation 3 minutes（T4）,after intubation 5 minutes（T5）,after intubation for 10 minutes（T6）.The incidence of adverse reactions to the anesthesia and satisfaction of anesthesia were recorded.【Results】 The loss of eyelash reflex time was significant difference of group Ⅰ than that of group Ⅱ（P 0.05）,group Ⅰslower than group Ⅱ.The body movement and muscle trembling In group Ⅰ were significantly decreased（P 0.05）;There were a statistically significant difference of the strange smell in group Ⅰand group Ⅱ（P 0.05）;The patients satisfaction of anesthesia in two groups are high.The SBP of two groups were statistically significant difference at the T2,T4,T5,T6 time points.The DBP and MAP at the T2,T3,T4,T5,T6 time points were statistically significant difference between the two groups.The blood pressure of two groups were a downward trend after the induction.There were no statistical difference of the HR of two groups at difference time points.The HR of two groups raised after tracheal intubation,then decreased gradually.The comparison of SPO2 of two groups at the T4,T5,T6 time points were statistically different,but SPO2 were more than 99%,no clinical significance.【Conclusion】 8% Sevoflurane induction are slower than Etomidate indution,but no clinical significance;the adverse reaction is low,the patient satisfaction is high.The hemodynamic changes of 8% Sevoflurane induction compard with Etomidate are significant.Therefore,the hemodynamic instability or elderly patients should be paid attention to maintain hemodynamic stability with 8% Sevoflurane induction,or application of low concentration of Sevoflurane induction.