依托咪酯乳剂复合丙泊酚用于颅内动脉瘤栓塞术全麻维持的可行性研究

Feasibility of etomidate combined proprofol in maintenance of general anesthesia for embolization of in intracranial aneurysm

目的探讨依托咪酯乳剂复合丙泊酚用于颅内动脉瘤栓塞术全身麻醉维持的可行性。方法择期行颅内动脉瘤栓塞术患者120例，随机分为两组。P组（对照组）麻醉诱导后持续泵注瑞芬太尼和丙泊酚（瑞芬太尼0．004～0．005ms／kg／h，丙泊酚5～6mg，kg／11），维持BIS值40—60；E组（实验组）麻醉诱导后持续泵注瑞芬太尼和依托咪酯乳剂复合丙泊酚（瑞芬太尼0．004～0．005mg／kg／h，依托咪酯乳剂0．5～0．6mg／kg／h，丙泊酚2．5～3rntg／kg／h），维持BIS值40～60。分别记录两组患者的入室（T0）、手术开始（T1）、手术进行30min（T2）、手术进行60min（T3）、手术进行90min（T4）、停药（115）各时段血流动力学的变化、以及手术时间、术毕患者自主呼吸恢复时间。结果E组和P组：与T0比较，T1～T5时收缩压、舒张压、心率均显著低于基础值（P〈0．05），但麻醉过程中基本平稳（P〉0．05）；E组与P组比较：T2～T5时E组收缩压、舒张压、心率均明显高于P组（P〈0．05）。E组出现2例颅内血管痉挛，2例颅内动脉瘤破裂；P组出现3例颅内血管痉挛，1例颅内动脉瘤破裂。结论依托咪酯乳剂复合丙泊酚在颅内动脉瘤栓塞术全麻维持中较单纯丙泊酚对循环系统影响更小。

Objective To explore the feasibility of etomidate combined proprofol in the maintenance of general anesthesia for intracranial aneurysal embolization. Methods 120 cases of intracranial aneurysal embolization were randomly divided into two groups - control group of which intravenously continuous infusion of remifentanil and propofol （remifentanil 0.004-0.005mg/kg/h, propofol 5-6mg/kg/h） was given after induction of anesthesia to maintain BIS 40-60; and E group of which remifentanil with etomidate plus propofol （remifentanil 0.004-0.005mg/kg/h, etomidate 0.5~0.6 mg/kg/h, propofol 2.5-3mg/kg/h） was infused continuously folloeing the induction to keep the same BIS value. Hemodynamic changes were recorded at the points of patients＇ arrival time （T0）, beginning of the operation（T0, 30 minutes （T2）, 60 minutes （T3）, 90 minutes （T4）, time to stop anesthetics （T5）, operation time and spontaneous breathing recovery time. Results Compared To, the SBP, DBP, HR at TI-T5 were significantly lower than the basic value （P 〈 0.05）, and the anesthesia process was stable （P 〉 0.05）. There were 2 intraeranial vasospasms, and 2 intracranial aneurysm rupture in E group comparing 3 and 1 in C group respectively. Conclusion Etomidate plus propofol in maintenance of general anesthesia for intracranial aneurysmal embolization has less influence on circulation system than only propofol.