依托咪酯不同输注速度对全麻诱导期肌阵挛的影响

Effects of different infusion rates of etomidate on myoclonus during general anesthesia induction period

目的研究依托咪酯不同输注速度对全麻患者肌阵挛的影响。方法选取妇科全麻手术的患者90例,平均分成3组,每组30例,记录患者的入室平均动脉压(MAP)、心率(HR)。开通静脉后,在诱导期以不同的速度静脉输注总量为0.3 mg/kg的依托咪酯。输注速度:A组0.9 mg/(kg·min),B组0.45 mg/(kg·min),C组0.23 mg/(kg·min)。患者入睡后,记录肌阵挛的发生情况,然后给予0.1 mg芬太尼,0.15 mg/kg顺苯,并吸入6%七氟醚,2 min后给予插管。记录输注依托咪酯结束后1、5、8 min的MAP、HR。结果 B组肌阵挛的发生率低于A组,但B组与C组比较差异无统计学意义,其中B组发生肌阵挛的程度以1、2级为主,而A组和C组均以2、3级为主。给药后5 min,三组患者MAP升高,给药后8 min有所下降。三组心率比较差异无统计学意义。结论依托咪酯以一定的速度推注,可以减少肌阵挛的发生率并减轻其发生程度,本实验的最适速度是0.45 mg/(kg·min)。

Objective To study the effect of different infusion rates of etomidate on myoclonus during general anesthesia. Methods 90 patients with general anesthesia gynecological surgery were divided into three groups. The mean arterial pressure（MAP）,heart rate（ HR） were recorded. After opening veins,patients of the three groups received intravenous infusion of 0. 3 mg /kg etomidate by different speeds. The infusion speed of group A,group B and group C were 0. 9 mg /（kg·min）,0. 45 mg /（kg·min） and 0. 23 mg /（kg·min）. The patients＇ myoclonus occurrences were recorded after falling asleep,then 0. 1 mg fentanyl and 0. 15 mg /kg cis-atracurium was injected,and 6% sevoflurane was inhaled. The intubation was done after 2 min. The blood pressure,mean arterial pressure（ MAP） and heart rate（HR） at 1 min,5 min,8 min after injecting etomidate were recorded. Results The incidence of myoclonus in group B was lower than that of group A,no significant difference was found between group B and group C. The degree of myoclonus in patients of group B was 1 - 2,while the degree of group A and group C was 2 - 3. MAP of patients increased at 5 min after administration,and decreased at 8 min after administration. There was no significant difference in heart rate among the three groups. Conclusion Injecting etomidate at a certain speed can reduce the incidence and extent of myoclonus. The best speed of this study was 0. 45 mg /（kg·min）.