依托咪酯-丙泊酚合用与单用心血管反应的对比研究

Comparative study of cardiovascular effects of combined Etomidate + Propofol vs. their single use

目的：探讨依托咪酯-丙泊酚混合液在无抽搐电休克（MECT）麻醉中的应用价值。方法：150例行MECT治疗患者随机分成3组,分别应用依托咪酯-丙泊酚混合液（E-P组）、依托咪酯（E组）、丙泊酚（P组）麻醉,记录麻醉前（T0）、麻醉后意识消失时（T1）、治疗即刻（T2）、治疗后1min（T3）、3min（T4）、5min（T5）的HR、SBP、DBP,计算HR与SBP的乘积（RPP）;记录麻醉过程中患者出现的注射疼、恶心呕吐、分泌物过多不良反应。结果：T1时3组SBP、DBP明显低于T0时,HR、RPP明显高于T0时;T2-T5时P组SBP、DBP、HR、RPP明显低于E-P、E两组,且E组HR、RPP高于E-P组,T2-T3时SBP、DBP、HR、RPP明显高于T0时,T4时E、E-P组SBP、DBP、HR、RPP明显高于T0时,P组DBP、HR、明显高于T0时,RPP明显低于T0时;T5时E组HR、RPP明显高于,E-P、P组SBP、DBP、HR、RPP明显低于T0时,比较均有统计学意义（P〈0.05）;注射疼P组明显高于E-P、E组（P〈0.05）,分泌物过多E组明显高于E-P、P组（P〈0.05）,恶心呕吐3组患者无差别。结论：依托咪酯—丙泊酚混合液应用于MECT麻醉优于两种药物的单独应用。

Objective：To explore the value of Etomidate ＋ Propofol in anesthesia of modified electroconvulsive therapy （ MECT） . Methods：A total of 150 patients undergoing MECT were randomly assigned to three groups and anesthetized with Etomidate＋ Propofol （ E-P group） , Etomidate （ E group） and Propofol （ P group） , respectively. Their heart rate （ HR） , systolic （ SBP） and diastolic blood pressure （DBP） were recorded before anesthesia （T0）, at the loss of consciousness after anesthesia （T1）, at instant treatment （T2） and at 1 （T3）, 3 （T4） and 5 min （T5） after the treatment. The heart rate-pressure-product （RPP） were calculated. The adverse reactions during anesthesia were recorded as injection pain, nausea/vomiting and excessive secretions. All data were processed with the SPSS V. 12. 0, and inspection standard of P〈0. 05 had statistical significance. Results： SBP and DBP of the three groups at T1 were significantly lower than those at T0, while HR and RPP at T1 were significantly higher than those at T0. From T2 to T5, SBP, DBP, HR and RPP of P group were significantly lower than those of E-P and E groups, and HR and RPP of E group were higher than those of E-P. SBP, DBP, HR and RPP at T2 and T3 were significantly higher than those at T0. At T4, SBP, DBP, HR, and RPP of E and E-P groups were significantly higher than those at T0;DBP and HR of P group were significantly higher than those at T0, while RPP was significantly lower than that at T0. At T5, HR and RPP of E group were significantly higher than those at T0;SBP, DBP, HR and RPP of E-P and P groups were significantly lower than those at T0 （P〈0. 05）. Injection pain in P group was significantly higher than those in E-P and E groups （P〈0. 05）, so were excessive secretions in E group than E-P and P groups （P〈0. 05）. There were no significant differences in nausea/vomiting among the three groups. Conclusions：Etomidate＋Propofol in the anes-thesia of MECT has an advantage over their single use.