麻醉深度指数指导下依托咪酯用于老年高血压患者全身麻醉诱导的临床研究

Etomidate induction of general anesthesia guided by cerebral state index in elderly hypertensive patients

目的通过靶控输注丙泊酚与依托咪酯对比，探讨应用麻醉深度指数（cst）监测在老年高血压患者的全身麻醉诱导期对血流动力学和应激反应的影响。方法择期行腹腔镜胆囊切除术的老年高血压1—2期患者40例，ASA分级I～Ⅱ级，将患者按随机数字表法分为丙泊酚组和依托咪酯组，每组20例，观察记录两组麻醉诱导前、气管插管前1min及气管插管后1、3、5min的CSI、平均动脉压（MAP）、心率、血糖、皮质醇。结果两组麻醉诱导前CS!、MAP、心率、血糖、皮质醇比较差异无统计学意义（P〉0．05）。两组气管插管前1min及气管插管后1和3minCSI明显低于麻醉诱导前，但气管插管后1和3min较气管插管前1min明显升高，差异有统计学意义（P〈0．05）。依托咪酯组气管插管前1min及气管插管后1、3、5minMAP明显高于丙泊酚组1（85．9±9．2）mmHg（1mmHg=0．133kPa）比（70．8±8．1）mmHg、（112．6±9．8）mmHg比（90．6±10．8）mmHg、（96．5±8．2）mmHg比（86．5±8．6）mmHg、（95．2±8．3）mmHg比（80．6±8．7）mmHg]，差异有统计学意义（P〈0．05）。丙泊酚组气管插管前1min心率明显低于麻醉诱导前和同期依托咪酯组[（65．1±6．2）次/min比（85．8±10．2）次／min，（78．2±6．7）次／min]，差异有统计学意义（P〈0．05），依托咪酯组各时间点心率比较差异无统计学意义（P〉0．05）。两组气管插管前1min血糖和皮质醇较麻醉诱导前明显降低，而气管插管后1、3、5min血糖和皮质醇较麻醉诱导前明显升高，差异有统计学意义（P〈0．05）；依托咪酯组气管插管前1min及气管插管后1、3、5min皮质醇较同期丙泊酚组明显降低[（260．6±39．6）nmol／L比（290．2±35．6）nmol／L、（380.3±37．6）nmol／L比（410．8±46．6）nmol／L、（361．2±25．2）nmol／L比（392．6±31．6）nmol／L、（352．3±25．6）nmol／L比（370.3±28．8）nmol／L]，差异有统计学意义（P〈0．05）。结论在CSI指导下对老年高血压患者进行全身麻醉诱导，靶控输注依托咪酯有更稳定的血流动力学，能有效抑制气管插管的应激反应。

Objective To study the effect of target controlled infusion of etomidate and propofol during general anesthesia induction period on haemodynamics and stress by cerebral state index （CSI） in elderly hypertensive patients. Methods Forty ASA I or I1 elderly hypertensive patients undergoing selective laparoscopie cholecystectomy were randomly divided into two groups by random digits table method with 20 cases each： propofol group and etomidate group. CSI, mean arterial pressure （MAP）, heartrate, blood glucose, concentration of plasma eortisol in the two groups were observed before induction of anesthesia, at 1 min before intubation, and at 1 min, 3 min and 5 min after intubation. Results The level of CSI, MAP, heart rate, blood glucose, cortisol between two groups at before induction of anesthesia had no significant difference （P 〉 0.05）. The levels of CSI in two groups at I rain before intubation, and at 1 min, 3rain after intubation were significantly lower than that at beforeinduction of anesthesia, but compared with that at 1 rain before tracheal intubation, CSI was significantly higher in two group at 1 min, and 3 min after intubation, and there was significant difference （P 〈 0.05）. The level of MAP in etomidate group was higher than that in propofol group at 1 min before intubation, and at 1 min , 3 min and 5 min after intubation： （85.9 ± 9.2） mmHg （1 mmHg = 0.133 kPa） vs. （70.8 ±8.1） mmHg, （112.6±9.8） mmHg vs. （90.6 ± 10.8） mmHg, （96.5 ± 8.2） mmHg vs. （86.5 ± 8.6） mmHg, （95.2 ± 8.3） mmHg vs. （80.6 ± 8.7） mmHg, and there was significant differenee （P 〈 0.05）. The level of heart rate at 1 min before intubation in propofol group was lower than that before induction of anesthesia and that at the same period in etomidate group： （65.1 ± 6.2） bpm vs. （85.8 ± 10.2） bpm, （78.2 _＋ 6.7） bpm], and there was signifieant difference （P 〈 0.05）, while there was no signifieant differene in the level of heart rate in etomidate group at each time point （P 〉 0.05）. Compared with before induction of anesthesia, the concentrations of blood glucose and cortisol at lmin before intubation in patients of the two groups decreased significantly, while glueose and eortisol coneentrations at 1 rain, 3 min and 5 min after intubation in two group signifieantly inereased, and there was significant difference （P 〈 0.05）; eortisol eoneentration in etomidate group at 1 min before intubation and 1 rain, 3 min, 5 min after intubation was signifieantly lower than that at the same period in propofol group： （260.6± 39.6） nmol/L vs. （290.2 ± 35.6） nmol/L, （380.3 ±37.6） nmol/L vs.（410.8 ±46.6） nmol/L, （361.2±25.2） nmol/L vs. （392.6± 31.6） nmol/L, （352.3± 25.6） nmol/L vs. （370.3 ±28.8） nmol/L, and there were significant differences （P 〈 0.05）. Conclusions During induction of general anesthesia with the guidanee of cerebral state index, target controlled infusion of etomidate has more stable hemodynamies, and also attenuates the stress response to tracheal intubation in elderly hypertensive patients.