依托咪酯乳剂靶控输注用于妇科腹腔镜手术的可行性

Feasibility of Target Controlled Infusion of Etomidate Emulsion in Gynecological Laparoscopic Surgery

目的探讨依托咪酯乳剂靶控输注(TCI)全凭静脉麻醉(TIVA)用于妇科腹腔镜手术的可行性及安全性。方法选择100例择期全麻下妇科腹腔镜手术的患者,ASAI～II级,随机分为依托咪酯组(E组n=50)和丙泊酚组(P组n=50),麻醉诱导:E组依托咪酯乳剂靶控诱导效应室浓度0.6μg/mL,P组给予依托咪酯乳剂0.3mg/kg,其余药物相同。术中麻醉维持:E组靶控效应室浓度改为0.3μg/mL,P组4～8mg/(kg h)的丙泊酚,两组患者均复合瑞芬太尼泵注,维库溴铵维持肌松。术中维持循环稳定,脑电双频指数(BIS)值维持在40～60,手术结束前30min接静脉镇痛泵。分别于麻醉前、诱导后、插管后、切皮后5 min、切皮后30 min、手术结束时观察心血管反应、BIS值的变化及苏醒情况。结果两组患者术中血流动力学均较稳定,但E组的波动明显低于P组;术毕苏醒时间,P组明显短于E组(P<0.05)。结论依托咪酯乳剂对心血管反应的影响比丙泊酚小,更适合患者的全麻维持;但术后烦躁发生率较高,应引起足够的重视。

Objective To investigate the feasibility and safety of etomidate emulsion by TCI （target controlled infusion） during TIVA （total intravenous anesthesia） in gynecological laparoscopic surgery. Methods General anesthesia patients with 100 cases, ASA Ⅰ-Ⅱ, undergoing selective gynecological laparoscopic surgery were randomly divided into Etomidate group （E ,n=50） and Propofol group（ P ,n=50）.Anesthesia induction： The patients in group E were given TCI etomidate emulsion at an EC of 0.6 μg/mL, as those in group P etomidate emulsion 0.3mg/kg, and the rest of the drugs were in the same. Anesthesia maintenance ： Remifentanil and Vecuronium were combined in both groups with the same dose,while the EC of etomidate in group E was reduced to 0.3μg/mL, and group P were set with Propofol 4 - 8mg/（kg.h） as the controls. During perioperative period, the circulation maintained steady, with BIS index at 40-60,and intravenous analgesia was used 30 minutes before the operation was over. Observe and record cardiovascular response,BIS index changes and anesthesia recovery condition before anesthesia, after induction, 5min and 30min after incising, and at operation end. Results The stable hemodynamics in both groups can be maintained during operation, but the fluctuation was significantly lower in group E than that in group P （P〈0.05）; Recovery time after operation of group P was shorter than that of group E（P〈0.05）.Condusion Etomidate emulsions is more suitable for patients with less cardiovascular effects during the maintenance of general anesthesia than Propofol;However, the postoperative agitation incidence is higher comparatively, which shold be given nough attention.