依托咪酯脂肪乳快通道麻醉在甲状腺手术中的临床观察

Clinical Effect of Fast-track Anesthesia of Etomidate to Thyroid Surgery

目的 探讨依托咪酯脂肪乳快通道麻醉用于甲状腺手术的麻醉效果和安全性。方法 将ASAⅠ～Ⅱ级60例择期行甲状腺全切或次全切患者以抽签形式随机分为实验组（Ⅰ组）和对照组（Ⅱ组）各30例。实验组采用依托咪酯维持麻醉,对照组采用丙泊酚维持麻醉。术中两组均维持脑电双频指数（BIS）在40～50。记录诱导前、切皮前、切皮时、游离甲状腺时、缝皮时、拔管时的平均动脉压（MAP）、心率（HR）、BIS值、呼末二氧化碳分压（PETCO2）;记录麻醉时间（T1）、手术时间（T2）、BIS达90的时间（T3）、苏醒时间（T4）、拔管时间（T5）、PACU停留时间（T6）;统计血管活性药使用情况;记录并发症。结果 两组切皮前和缝皮时的平均动脉压和心率均明显低于诱导前（P〈0.01）;Ⅱ组切皮前、切皮时、缝皮时的平均动脉压明显比Ⅰ组低（P〈0.01）;两组T1、T2、T3、T4、T5、T6比较无统计学意义（P〉0.05）;Ⅰ组去氧肾上腺素用量少于Ⅱ组（P〈0.05）。结论 1依托咪酯脂肪乳或丙泊酚复合瑞芬太尼全凭静脉麻醉用于甲状腺手术,均能使患者苏醒快,PACU停留时间短。2依托咪酯脂肪乳复合瑞芬太尼全凭静脉麻醉麻醉血流动力学更稳定。

Objective To evaluate anesthetic effect and security of fast-track anesthesia of etomidate to thyroid surgery. Methods Sixty patients ofASA Ⅰ - Ⅱ scheduled for total thyroidectomy or thyroidectomy cut were randomly divided into two groups of experimental group（ group Ⅰ） and control group（ group Ⅱ）,eaeh one with 30 patients. The patients in group Ⅰ were maintained with etomidate, and the patients in group Ⅱ were maintained with propofol. Bispectral index （BIS） values in two groups was maintained between 40 and 50.The mean arterial pressure（MAP）, heart rate （HR）,BIS values and PErCO2 were recorded before anesthesia induction, before skin incision, when skin incision, thyroid dissociated, skin closure and tracheal extubation. The duration of anesthesia（T0, operation time（T2）, time of BIS value up to 90（T3）, recovery time（T4）, tracheal extubation（Ts）, PACU residence time（T6） and dosages of vasoactive drugs, and complications were recorded. Results The MAP and HR before skin incision and skin closure is obviously lower than before anesthesia in both groups （P〈0.01）; The MAP before skin incision, when skin incision, skin closure in group Ⅱ is lower than in group I （P〈0.01）; TI, T2, T3, T4, T5, T6 in group I is no longer than that in group 11 （P〉0.05）.The dosages of phenylephrine in group I is less than that in group 11 （P〈0.05）. Conclusions ①There are shorter time and rapid analepsia by etomidate or propofol combined with remifentanil on intravenous anesthesia to thyroid surgery. ②There are minimal effects on cardiovascular function by etomidate combined with remifentanil on intravenous anesthesia.