依托咪酯乳剂与丙泊酚全凭静脉麻醉在妇科腹腔镜手术中的应用比较

Comparison of Intravenous Anesthesia of Etomidate Emulsion or Propofol in Gynecological Laparoscopic Operation

目的:比较依托咪酯乳剂与丙泊酚联合瑞芬太尼全凭静脉麻醉对妇科腹腔镜手术患者血流动力学的影响与安全性。方法:将择期行妇科腹腔镜手术患者60例随机均分为依托咪酯组(E组)与丙泊酚组(P组)。分别应用依托咪酯乳剂或丙泊酚联合瑞芬太尼全凭静脉麻醉。观察两组患者围麻醉期各时间点血流动力学的变化及停药后患者各阶段恢复时间,以及用药后患者反应、术后24h内不良反应发生情况。结果:诱导时,P组收缩压(SBP)、舒张压(DBP)和心率(HR)与麻醉前比较显著下降(P<0.05),而E组则轻度下降或下降不显著(P>0.05);气管插管时及插管后1min,P组SBP与DBP显著高于诱导前(P<0.05),而E组轻度升高(P>0.05),插管后3～5min和手术开始时,P组SBP与DBP也显著升高,而E组SBP与DBP低于P组(P<0.05)。在整个围麻醉期间,E组血压及HR与P组比较波动较小,而两组患者自主呼吸恢复、睁眼、拔除气管导管及清醒时间比较无显著性差异(P>0.05)。两组患者均未见严重不良反应发生。结论:依托咪酯乳剂全凭静脉麻醉时血流动力学比丙泊酚更加稳定,对循环功能干扰轻,更适合用于时间短、恢复快的妇科腹腔镜手术麻醉。

OBJECTIVE：To compare the effects,clinical efficacy and safety of total intravenous anesthesia of Etomidate emulsion or propofol combined with remifentanil on hemodynamics of patients underwent gynecological laparoscopic operation.METHODS：60 patients undergoing elective gynecological laparoscopic operation were randomized into etomidate group（group E） and propofol group（group P）.The hemodynamic changes of patients in 2 groups were observed at different time points of stage of anesthesia,and recovery time was alos observed after drug withdrawal.The response of patients after the injection and the occurrence of ADR within 24 h after operation were observed.RESULTS：During induction,SBP,DBP and HR of group P decreased obviously,compared with before anesthesia（P0.05）;those of group E declined slightly or had no evident decrease（P0.05）.SBP and DBP of group P during tracheal intubation and 1 min after intubation were significantly higher than before induction（P0.05）,and those of group E increased slightly（P0.05）.SBP and DBP of group P increased significantly 3-5 minutes after intubation and at the beginning of operation,and those of group E were lower than group P（P0.05）.Perianesthetic blood pressure and heart rate of group E had no significant change,compared with group P;while autonomic respiratory recovery,goggle,extubation and awake time had no significant difference between 2 groups（P0.05）.There was no serious ADR found in both groups.CONCLUSIONS：The hemodynamics of gynaecological laparoscopic operation patients with general anesthesia of etomidate is more stable than propofol,less interference on the circulatory function,and it is suitable for a short time,rapid recovery of laparoscopic operation anesthesia.