依托咪酯与丙泊酚对异位妊娠失血性休克患者全身麻醉诱导时循环系统以及麻醉深度影响的比较

Effect of Etomidate and Propofol on the Circulatory System and the Depth of Anesthesia of Patients with Ectopic Pregnancy Joint Uncontrolled Hemorrhagic Shock during the Induction of General Anesthesia

目的比较依托咪酯与丙泊酚对异位妊娠失血性休克患者全身麻醉诱导时循环系统以及麻醉深度的影响。方法选取2013年5月至2015年4月于双流县第一人民医院进行治疗的80例异位妊娠失血性休克患者为研究对象,采用随机数字表编码法分为依托咪酯组和丙泊酚组,各40例。依托咪酯组给予咪唑安定+芬太尼+依托咪酯+维库溴胺诱导插管;丙泊酚组给予咪唑安定+芬太尼+丙泊酚+维库溴胺诱导插管。监测记录两组患者麻醉前(T_1)、诱导中(T_2)及维持后10 min(T_3)、30 min(T_4)、50 min(T_5)的心率、平均动脉压(MAP)、脑电双频指数(BIS)和脉搏血氧饱和度(Sp O_2)。结果两组T_2心率均较T1时下降,T_3、T_4、T_5时均回升[依托咪酯组:(91±8)次/min、(110±6)次/min、(111±9)次/min、(107±8)次/min比(108±9)次/min;丙泊酚组:(86±5)次/min、(105±7)次/min、(109±9)次/min、(102±6)次/min比(107±8)次/min],保持平稳,依托咪酯组各时间点心率均高于丙泊酚组(P<0.05)。依托咪酯组T_2、T_3、T_4、T_5时MAP呈先上升后下降趋势,丙泊酚组呈下降趋势[依托咪酯组:(53±7)mmH g(1 mmHg=0.133 kP a)、(54±7)mmHg、(55±9)mmHg、(54±6)mmHg;丙泊酚组:(46±8)mmHg、(46±8)mmHg、(45±7)mmHg、(43±6)mmHg],依托咪酯组各时点MAP高于丙泊酚组(P<0.05)。依托咪酯组和丙泊酚组所有患者SpO_2均为100%。依托咪酯组和丙泊酚组T_2、T_3、T_4、T_5时BIS较诱导前显著降低(P<0.05),两组间、不同时间点、组间·不同时间点交互作用比较差异无统计学意义(P>0.05)。结论依托咪酯用于异位妊娠失血性休克患者全身麻醉诱导时循环系统稳定性优于丙泊酚,且两种药物所致麻醉深度无明显差异。

Objective To compare the effect of etomidate and propofol on the circulatory system and the depth of anesthesia of patients with ectopic pregnancy joint uncontrolled hemorrhagic shock during the induction of general anesthesia. Methods Total of 80 patients with ectopic pregnancy joint uncontrolled hemorrhagic shock treated in Shuangliu County First People＇s Hospital between May 2013 and Apr. 2015 were divided into etomidate group and propofol group according to the random number table method, 40 cases each. The etomidate group was given midazolam ± fentanyl ± etomidate ± vecuronium intubation; the prepofol group was administered midazolam ± propofol ± fentanyl vecuronium intubation. The mean arterial pressure （ MAP）, heart rate （ HR ）, brain electric bispectral index （ BIS ） and pulse oximetry （ SpO2 ） at the time points of before anesthesia （T1 ）, induction （ T2 ） and 10 rain （ T3 ） were maintained, 30 min （ T4 ） ,50 min （ T5 ） of the two groups were monitored and recorded. Results Heart rate of both groups decreased significantly at T2, then both increased at T3 , T4, T5 compared with Tt [ etomidate group：（91 ± 8 ） times/min, （ 110 ± 6 ） times/min, （ 111 ± 9 ） times/min, （ 107 ± 8 ） times/rain vs （ 108± 9 ） times/min; propofol group ： （86 ± 5） times/min, （ 105 ± 7 ） times/min, （ 109 ± 9） times/min, （ 102 ± 6） times/min vs （ 107 ± 8） times/mini ,then remained stable, and the etomidate group at each time points were higher than the propofol group（ P 〈 0. 05 ）. At T2,T3 , T4, T5 MAP of the etomida te group first increased then decreased, the propofol decreased[etomidate group：（53 ±7） mmHg,（54 ±7） mmHg,（55 ±9） mmHg,（54 ±6） mmHg; propofol groups：（46 ±8） mmHg, （46 ±8） mmHg,（45 ±7） mmHg,（43 ±6） mmHg] ,and the etomidate group at each time point was higher than the propofol group（P 〈0. 05）. SpO2 of both groups was 100%. BIS of both groups at T2 , T3 , T4, Ts were significantly decreased from before induction （ P 〈 0. 05 ）, the differences between groups, between different lime points and interaction of groups and different time points were not statistically signifieant（ P 〉 0. 05 ）. Conehmion Etomidate is better than propofol for patients with ectopic pregnancy joint uncontrolled hemorrhagic shock during the induction of general anesthesia with regards to circulatory system stability,but there＇s no significant difference in the depth of anesthesia.