航海刺激对患者丙泊酚和依托咪酯麻醉敏感性的影响

Comparitive Study on the Effects of Navigation Stimulation on Patients' Anesthetic Sensitivity of Propofol and Etomidate

目的对比研究航海刺激对患者丙泊酚和依托咪酯麻醉敏感性的影响,为海上环境下合理选用丙泊酚和依托咪酯提供依据。方法采用旋椅试验制备运动病临床模型。75例患者随机分为5组(n=15)。对照组(Ⅰ组):只旋转,不麻醉。丙泊酚麻醉组(Ⅱ组):单剂丙泊酚麻醉,不旋转。依托咪酯麻醉组(Ⅲ组):单剂依托咪酯麻醉,不旋转。丙泊酚研究组(Ⅳ组):先旋转,再丙泊酚麻醉。依托咪酯研究组(Ⅴ组):先旋转,再依托咪酯麻醉。连续监测收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏氧饱和度(pulse oxygen saturation,SpO2)、呼气末二氧化碳分压(end-tidal carbon dioxide pres-sure,PETCO2)以及熵指数、Ramsay镇静评分的动态变化。结果应用丙泊酚后,患者血压(blood pressure,BP)、SpO2明显降低,而应用依托咪酯后患者BP、SpO2无明显变化,两种药物间(Ⅲ-Ⅱ、Ⅴ-Ⅳ)比较均有统计学意义(P<0.05)。丙泊酚或依托咪酯研究组与麻醉组(Ⅳ-Ⅱ、Ⅴ-Ⅲ)BP和SpO2比较,无统计学差异。Ⅰ组HR明显减慢,ETCO2显著降低;Ⅱ组HR明显增快,ETCO2显著升高;Ⅲ、Ⅳ、Ⅴ组HR和ETCO2基本平稳。Ⅱ～Ⅴ组反应熵(response entropy,RE)/状态熵(state entropy,SE)迅速降低,Ramsay评分明显升高,部分指标10min时仍未完全恢复。丙泊酚或依托咪酯研究组RE/SE均明显低于麻醉组,Ramsay评分明显高于其麻醉组(P<0.05)。Ⅲ组RE/SE在30s、1min和3min三个时点明显高于Ⅱ组(P<0.05),而在1.5min和2min时与Ⅱ组无明显差异;Ⅴ组和Ⅳ组RE/SE、Ramsay评分无明显差异,特别是在1.5min后两组的SE、Ramsay评分基本相等。结论航海刺激可明显增加患者对丙泊酚和依托咪酯的麻醉敏感性,航海状态下使用依托咪酯似有更多优越性。

Objective To compare the effects of navigation stimulation on the patients＇ anesthetic sensitivity of propofol and etomidate,so as to provide reference for rational use of propofol or etomidate during navigation.Methods Rotation-chair test was used to establish clinical model of motion sickness.A total of 75 patients were randomly divided into 5 groups（n=15 each）.Control（Ⅰ） group： only rotation,no anesthesia.Propofol anesthesia（Ⅱ） group： single dose of propofol injection,no rotation.Etomidate anesthesia（Ⅲ） group： single dose of etomidate injection,no rotation.Propofol study（Ⅳ） group： rotation first before a dose of propofol injection.Etomidate study（Ⅴ） group： rotation first before single dose of etomidate injection.The dynamic changes of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SpO2）,end-tidal carbon dioxide pressure（PETCO2）,entropy index and Ramsay＇s sedative score were measured continuously.Results The blood pressure（BP） and SpO2 of the patients were obviously reduced after propofol injection,but didn＇t significantly change in patients after etomidate injection,and there was significant difference between groups Ⅲ and Ⅱ,and groups Ⅴ and Ⅳ using different drugs（P0.05）.There was no significant difference in BP and SpO2 between the corresponding study and anesthesia groups（Ⅳ vs Ⅱ、Ⅴ vs Ⅲ）.In group Ⅰ,HR and PETCO2 were reduced obviously.In group Ⅱ,HR and PETCO2 were increased significantly.HR and PETCO2 were stable in groups Ⅲ,Ⅳ and Ⅴ.In groups Ⅱ~Ⅴ,response entropy（RE）/state entropy（SE） were reduced rapidly,Ramsay＇s sedative score were increased significantly,and several indexes were not wholly recovered during 10 minutes.RE/SE was lower and Ramsay＇s sedative score was higher（P0.05） in propofol or etomidate study groups than that in the corresponding anesthesia groups.RE/SE were higher in group Ⅲ than in group Ⅱ at 30 seconds,1 minute and 3 minutes.There was no significant difference between groups Ⅲ and Ⅱ at 1.5 minutes and 2 minutes.There was no significant difference in RE/SE and Ramsay＇s sedative score between groups Ⅴ and Ⅳ.SE and Ramsay＇s sedative score of these two groups were to some exten equal after 1.5 minutes.Conclusion Navigation stimulation can obviously increase the patients＇ anesthetic sensitivity of propofol and etomidate and.etomidate has better effect.