靶控输注依托咪酯应用于颅内支架成形术的对比研究

Contrast study of target controlled infusion of etomidate used in intracranial stenting

目的:比较靶控输注依托咪酯与丙泊酚应用于颅内支架成形术的麻醉效果和不良反应。方法:择期行颅内支架成形术患者40例,随机分为依托咪酯组(E组)和丙泊酚组(P组),每组20例。E组靶控输注依托咪酯麻醉诱导并维持,P组靶控输注丙泊酚诱导并维持。记录入室时(T0),放置喉罩前(T1)、放置喉罩即刻(T2)、放置喉罩后5min(T3)、股动脉穿刺置管时(T4)、介入支架植入时(T5)、拔除喉罩后1min(T6)的SBP、DBP、HR、PETCO2及术毕自主呼吸恢复时间(T7)、苏醒时间(T8)、拔除喉罩时间(T9)。观察两组患者不良反应情况。结果:P组患者诱导后SBP、DBP、HR明显下降,尤其是SBP、DBP在T1、T3、T53个时间点均显著低于基础值且两组差异有统计学意义(P<0.05)。循环抑制、注射痛发生率P组多于E组,而肌颤、恶心呕吐发生率E组多于P组。E组苏醒时间显著长于P组(P<0.05)。结论:靶控输注依托咪酯应用于颅内支架成形术血流动力学稳定,麻醉效果满意,不良反应少,为一种安全的麻醉方法。

Objective To compare the anesthetic effect and the adverse reactions between targeted controlled infusion of etomidate and propofol used in intracranial stenting. Methods Forty patients undergoing intracranial stenting in selective time were randomly divided into etomidate group （group E） and propofol group （group P）, 20 patients in each group. Group E received targeted etomidate anesthesia of control infusion on induction and maintain, group P received propofol anesthesia of targeted controlled infusion on induction and maintain. The SBP, DBP, HR, PETCO2 and recovery time of spontaneous breathing （T7） after the surgery, awake time （T8）, extubation time （T9） were respectively recorded at the time of entering into the operating room （T0）, before the laryngeal mask insertion （T1）, the laryngeal mask insertion immediately （T2）, 5 min after laryngeal mask insertion （T3）, the femoral artery puncture （T4）, interventional stents implantation （T5）, 1 min after the laryngeal mask pulled out （T6）. Adverse reactions of the two groups were observed. Results The SBP, DBP, HR decreased significantly in group P after induction, especially the SBP and DBP in T1, T3, Ts, which were significantly lower than basic value （P 〈 0.05）. The rates of circulatory inhibition, injection pain of group P were more than group E, while the rates of muscle vibration, nauseating, vomiting of group E were more than group P. The awake time of group E was significantly longer than group P （P 〈 0.05）. Conclusion The targeted controlled infusion of etomidate used in intracranial stenting is a safe method of anesthesia with intraoperative hemodynamic stability, satisfactory anesthesia effect and few adverse effects.