依托咪酯与异丙酚全麻诱导对宫外孕腹腔镜手术循环系统和麻醉深度的影响比较

Comparative observation of the effect of etomidate and propofol on circulatory system and the depth of anesthesia in laparoscopic surgery of ectopic pregnancy

目的依托咪酯与异丙酚全麻诱导对宫外孕腹腔镜手术循环系统和麻醉深度的影响。方法选择2016年3月-2016年9月来瑞安市人民医院进行宫外孕腹腔镜手术患者40例,按照完全随机分组原则分为依托咪酯组和异丙酚组,各20例。分别评估2组患者麻醉过程中4个时间点的血流动力学指标的变化和脑电双频指数（bispectral index,BIS）变化,记录2组患者术后出现恶心呕吐、寒战和气管痉挛的情况。结果入室时（T0）、插管后1 min（T2）和插管后5 min（T3）2组患者的心率（heart rate,HR）、收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）没有显著差异,但在诱导时（T1）,与依托咪酯组患者比较,异丙酚组患者的HR、SBP显著降低,DBP显著升高（P〈0.05）,依托咪酯组和异丙酚组患者在诱导时（T1）HR、SBP较T0时显著下降,DBP显著升高（P〈0.05）。4个时间点2组患者的BIS都没有显著差异,在T1、T2和T32组患者的BIS都显著低于T0（P〈0.05）。2组出现3种并发症的比例没有显著差异。结论依托咪酯与异丙酚相比,可以更好地控制全麻诱导时的心血管反应,2种药物麻醉深度一致,并发症发生率没有差异,更适用于宫外孕患者的腹腔镜手术中。

Objective To investigate the effects of etomidate and propofol on circulatory system and the depth of anesthesia in laparoscopic surgery of ectopic pregnancy. Methods From January 2014 to January 2015,40 patients with ectopic pregnancy in our hospital were selected and divided into the etomidate group and propofol group according to the principle of complete random grouping. Patients in the etomidate group received etomidate induced anesthesia,and the patients in the propofol group received propofol induced anesthesia. Hemodynamic parameters and bispectral index（BIS） of two groups were evaluated at 4 time points. The incidence of postoperative nausea and vomiting,chills and bronchospasm were recored. Results There was no significant difference in heart rate（HR）,systolic blood pressure（SBP） and diastolic blood pressure（DBP） between the two groups at T0,T2 and T3. But at the time of induction（T1）,the heart rate of patients in propofol group was significantly lower than that in etomidate group（P〈0. 05）. While T1,compared with etomidate group,the HR and SBP significantly decreased and DBP increased in the propofol group（P〈0. 05）,The HR and SBP at T1 of patients in the propofol group and etomidate group decreased significantly and DBP increased when compared with T0（P〈0. 05）. and etomidate group decreased significantly compared with T0（P〈0. 05）. There were no significant differences in BIS indexes at four time points. However,BIS indexes at T1,T2 and T3were significantly lower than T0（P〈0. 05）. There was no significant difference in three kinds of complications rates in two groups. Conclusion Etomidate,compared with propofol,can better control the cardiovascular response during induction of anesthesia. Both drugs have a consistent depth of anesthesia. There is no difference in the incidence of complications. Etomidate is more suitable for patients with ectopic pregnancy laparoscopic surgery.