依托咪酯乳剂全凭静脉全麻在心脏手术中的临床应用

The application of etomidate fat emulsion anesthesia totally by intravenous in cardiac surgery

目的 探讨依托咪酯乳剂全凭静脉全麻在心脏手术中的可行性、安全性及麻醉效果。方法选择ASAII-Ⅳ，拟行心脏手术的患者100例，以咪达唑仑0．05-0．10mg／kg、依托咪酯0．15-0．20mg／kg、维库溴胺0．15mg／kg、舒芬太尼0．40．5μg／kg进行麻醉诱导，依托咪酯0．3-0．5mg·kg-1．h。持续输注维持全身麻醉，间断静注舒芬太尼（总量：2-3I．Lg／kg）、持续输注阿曲库胺0．5～0．8mg·kg-1．h。维持镇痛及肌松，缝皮结束后停止药物输入。记录患者诱导前（T1）、诱导后（T2）、气管插管后5min（T3）、停体外循环时（T4）、关胸时（T5）患者的有创血压（IBP）、心率（HR）；记录患者的清醒时间、拔管时间，术后随访有无术中知晓的发生。结果本组患者麻醉诱导后IBP、HR轻度下降，气管插管后IBP回复插管前水平。插管后5min患者IBP维持平稳，体外循环前无1例患者需要使用正性肌力药物维持血压。本组患者麻醉效果满意，无术中知晓的发生。患者术后2—4h清醒，拔管时间为（21±3．5）h。本组无死亡病例。结论依托咪酯乳剂全凭静脉全麻不仅能满足心脏手术的麻醉需求，且血流动力学稳定，可安全应用于心脏手术患者。

Objective To study the practicable and effect of etomidate tFat emulsion anesthesia totally by intravenous in cardiac surgery. Methods One hundred patients of undergoing cardiac surgery and ASA II -IV were anesthesia inducted with midazolam 0.05-0.10 mg/kg, etomidate 0.15-0.20 mg/kg, vecuronium 0.15 mg/kg and sulfentanyl 0.4-0.5 μg/kg, then were kept anesthesia with etomidate 0.3-0.5 mg.kg-h-1 by continuous infusion, sulfentanyl （ Total 2-3 μg/kg ） by intermittent injection, and were kept analgesia and muscle relaxant with tracium 0.5-0.8 mg.kg-h-1 by continuous infusion until the operation was over. The invasive blood pressure （IBP） and the heart rate （HR） of the patients were recorded in before the induction （T1）, after the induction （T2）, 5 win after tracheal intubation （T3）, time when stop the extracorporeal circulation and closed chest. The time of revival and drew the trachea was recorded. Whether or not occurred intraoperative awareness, were inquiried for each patient. Results The IBP and HR of the patients was mild decreased after anesthesia induction. The IBP was returned the level of before tracheal intubation, after tracheal intubation and was kept stable. And no patient need medication to increase blood pressure before CPB. The anesthesia effect was satisfaction. No intraoperative awareness has happened to all patients. The patients were revived in 2-4 hours. The time of drew the trachea was 21.0±3.5 hours after surgery. Conclusion Etomidate fat emulsion totally by intravenous anesthesia is a good and safe way in cardiac surgery, and it is stable on the hemodynamics.