持续静脉输注不同时间的依托咪酯对肾上腺皮质功能的影响

Effects of etomidate infusion with different duration on adrenocortical function

目的观察持续静脉输注不同时间的依托咪酯对肾上腺皮质功能的影响。方法选择择期手术患者60例,随机均分为六组,依托咪酯组(8～10μg·kg-1·min-1)分别持续输注依托咪酯乳剂1h(E1组),2h(E2组),4h(E4组);丙泊酚组(4～6mg·kg-1·h-1),分别持续输注丙泊酚1h(P1组),2h(P2组),4h(P4组)。于麻醉前5min(T0),给药后1h(T1),2h(T2),4h(T3),6h(T4),24h(T5)6个时点测定血中的皮质醇(Cor)、醛固酮(ALD)浓度和促肾上腺皮质激素(ACTH)含量。结果与T0时比较,T1、T2时E1组、T1～T3时E2和E4组Cor降低(P<0.05);T1、T2时E1组、T2、T3时E2组、T1～T4时E4组、T1时P2和P4组ALD浓度降低(P<0.05);T2时E2组、T2和T3时E4组ACTH含量升高(P<0.05)。六组各时点所有数值均在正常范围内,T5时80%的ALD浓度和所有Cor浓度、ACTH含量恢复至术前水平,未发生相关性肾上腺皮质功能不全的症状。结论依托咪酯对肾上腺皮质功能的抑制是短暂的,可安全地用于4h内无肾上腺皮质功能不全患者的全麻维持。

Objective To investigate the effects of etomidate infusion with different duration on adrenocortical function. Methods Sixty general anesthesia patients （ASA Ⅰ or Ⅱ ） underwent selective operation were randomly divided into 6 groups, etomidate group：. E1,E2 and E4 group （continuous infusion etomidate 1 h, 2 h and 4 h）, and propofol group： P1, P2 and P4 group （continuous infusion propofol 1 h, 2 h and 4 h）, 10 case each group. Anesthesia was maintained with infusion of etomidate 8-10 μg.kg-1.min-1 in group E, propofol 4-6 mg.kg-1.h-1 in group P. Blood samples for the measurement of cortisol, aldosterone and adrenocorticotrophic hormone （ACTH） were collected before induction 5 min （T0） and 1 h （T1）, 2 h （T2）, 4 h （T3）, 6 h （T4）, 24 h （Ts） after induction. Results Compared with To, the plasma levers of cortisol decreased at T1 and T2 in group E1 （P〈0.05）, decreased at T1-T3 in group E2 and E4 （P〈0.05）, no significant change in group P. Aldosterone decreased at T1 and T2 in group E1 （P〈0.05）, decreased at T2 and T3 in group E2 and T1-T4 in group E4 （P〈0.05）, decreased at T1 in group P2 and P4（P〈0. 05）. ACTH increased at T2 in group E2 （P〈0.05）, increased at T2 and T3in group E4 （P〈0.05）. All levels were normal, eighty percent of cortisol, all aldosterone and ACTH values could restore to preoperative level at T5. There were no adrenal insufficiency occurred in our study. Conclusion The inhibition of etomidate on the function of adrenocortical is temporal and safe for continuous infusion 4 h of those who are not hypoadrenocorticism.