依托咪酯乳剂全凭静脉全麻在重症瓣膜手术中的应用

The Application of Etomidate Fat Emulsion Total Intravenous Anesthesia in Intensive Cardiac Valvular Surgery

目的研究依托咪酯乳剂全凭静脉全麻在重症瓣膜手术中的可行性及临床疗效。方法选择拟行换瓣手术的重症瓣膜性心脏病患者80例，随机分为依托咪酯组（E组）和丙泊酚组（P组），每组40例。完成麻醉诱导插管后，E组选择依托咪酯0．3～0．6mg／（kg·h）、P组选择丙泊酚3～6mg／（kg·h）持续输注维持静脉全身麻醉，其余麻醉用药相同，对比两组患者的麻醉效果。结果E组患者体外循环前生命体征维持平稳，无1例使用药物提升血压；P组患者麻醉诱导后、气管插管后5min血压显著降低，有13例需使用去氧肾上腺素提升血压，2例体外循环前需持续泵输入多巴胺维持血压。两组患者体外循环时间、术后清醒时间及拔管时间差异无统计学意义。两组患者无一例发生术中知晓。结论依托咪酯乳剂全凭静脉复合全麻可安全应用于重症瓣膜手术，明显减轻麻醉对心脏功能的抑制，对血流动力学影响小，是一种较好的麻醉选择。

Objective To study the practicable and effect of etomidate fat emulsion total intravenous anesthesia in intensive cardiac valvular surgery. Methods Eighty patients of undergoing intensive cardiac valvular surgery were randomly and equally divided into 2 groups. Etomidate in group E was kept anesthesia with 0.3 - 0.6 mg/（ kg · h） and group P with the same dosage of propofol with 3-6 rag/（ kg · h） after achieved anesthesia induction. The anesthesia effect was compared. Results The vital sign of all patients in group E were kept stable before CPB, and no patient needed medication to increase blood pressure. A signif- icantly decrease of the blood pressure in group P was observed in 5 min after induction and tracheal intubation. Thirteen patients needed phenylephrine to increase blood pressure, and two patients needed continue pumping dopamine to maintain blood pressure before CPB. There wasn＇ t a striking difference between the groups on transit time and awakening time and extubation time. And no intraoperative awareness was happened to all patients. Conclusion Etomidate fat emulsion total intravenous anesthesia was a good way in intensive cardiac valvular surgery. It can significantly reduce the euppression of narcotic drugs on the myocardium, and it had mild effects on the hemodvnamics.