依托咪酯乳剂全凭静脉麻醉用于子宫全切术的临床观察

Clinical Observation of Total Intravenous Anesthesia with Etomidate in Hysterectomy

目的探讨依托咪酯乳剂用于全凭静脉麻醉维持的可行性及安全性。方法选择级择期行子宫全切除术患者120例,随机分为依托咪酯不同剂量组（E1组、E2组、E3组、）和丙泊酚组（P组）,每组30例。依次静脉推注咪唑安定0.03 mg/kg、芬太尼4μg/kg、维库溴胺0.1 mg/kg、依托咪酯0.3 mg/kg（E1~E3组）或丙泊酚2 mg/kg（P组）施行麻醉诱导。气管插管后用对E1~E3组分别采用依托咪酯10、15、20μg/（kg·min）持续静脉给药;P组采用丙泊酚6 mg/（kg·h）持续静脉给药。术中所有患者均复合瑞芬太尼0.3μg/（kg·min）维持麻醉。于麻醉前5 min（T1）、插管后5 min（T2）、切皮后5 min（T3）、牵拉子宫后5 min（T4）、拔管后5 min（T5）记录平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）的变化数值;记录患者的苏醒时间、拔管时间、肌阵挛、恶心呕吐及术中知晓发生情况。结果所有患者术中BIS值波动在40~60之间,未发生术中知晓。与T1相比,E1、E2、E3组T4时HR、MAP升高（P〈0.05）,P组T2时MAP降低（P〈0.05）。E2和E3组苏醒时间和拔管时间较P组延长（P〈0.05,P〈0.01）,4组病人满意度及不良反应发生例数比较,差异无统计学意义（P〉0.05）。结论依托咪酯[10μg/（kg·min）]维持给药具有镇静好,苏醒快,对循环干扰小,不良反应小,适用于子宫全切术全凭静脉麻醉维持给药。

Objective To study the feasibility and safety of total intravenous anesthesia with etomidate. Methods 120 patients undergoing hysterectomy were randomly divided into 4 groups with 30 cases in each： etomidate groups （group El, group E2 and group E3 according to the dose of etomidate） and propofol group （group P）. The patients were induced by midazolam 0.03mg/kg, fentanyl 4ug/kg, vecuronium bromide 0.1mg/kg, and etomidate 0.3 mg/kg （group E1 -E3） or propofol 2 mg/kg （group P）. After tracheal intubation, the anesthesia was maintained with etomidate 10ug/（kg. min） （group El）, 15ug/（kg. min） （group E2） and 20ug/ kg/min （group E3）, or witb propofol 6mg/kg.h （group P）. Remifentanil was also given to each group. MAP, HR, and BIS were recorded at 5 min before anesthesia （T1）, 5 min after tracheal intubation （T2）, 5 rain after cutting skin （373）,5 min after uterine stretch （T4）, and 5 rain after tracheal extubation （T5）; The time of recovering from sleep and drawing tube of the patients were recorded. The incidence rate of myoclonus, nausea, vomit and intraoperative awareness of all patients were monitored. Results The BIS of all the patients waved from 40 to 60; no intraoperative awareness had been observed. Compared with T1, the HR and MAP of group El ,E2, E3 were significantly higher at E4 （P〈0.05）, while MAP in group P was lower at T2 （P〈0.05）.The times of recovering from sleep and drawing tube of group E2 and E3 were obviously longer than those of group P （P〈0.05,P〈0.01）. There was no significant difference in the degree of satisfaction and adverse reaction cases of the 4 groups （P〉0.05）. Conclusion Intravenous anesthesia by maintaining injecting etomidatel0 ug/（kg .min）was suitable for hysterectomy with its good sedation, quick revival, little impaction on the circulation and less side effects.