依托咪酯和丙泊酚在全麻诱导中的应用

Application of propofol versus etomidate in patients undertaking general anesthesia

目的探讨全麻状态下依托咪酯和丙泊酚对患者血液流动学及不良反应的影响。方法选取本院2014年3月至2015年11月收治的择期腹腔镜胆囊切除术患者140例为研究对象，采用随机数字表法分为Group 1组（n=70，予丙泊酚进行麻醉诱导）和Group 2组（n=70，予依托咪酯进行麻醉诱导）。详细记录两组患者在麻醉诱导期间血压及心率变化，注射引发疼痛、呼吸暂停及肌阵挛等不良反应情况。结果Group 1组与Group 2组在各时间点心率、平均动脉压比较，差异有统计学意义（F=158.341、201.276，P〈0.05）。Group 1组50.00%患者均未感觉到麻醉诱导引起的注射疼痛反应，而Group 2组96.00%患者无麻醉诱导引起的注射疼痛反应，差异有统计学意义（Z=-2.143，P=0.032）。Group 1组全部患者在麻醉诱导后均未发生肌阵挛现象，而Group 2组有44例（62.86%）患者在麻醉诱导后未发生肌阵挛现象，26例（37.14%）患者在麻醉诱导后发生肌阵挛，差异有统计学意义（Z=-2.782，P=0.028）。Group 1组有38例（76.00%）患者在麻醉诱导后出现呼吸暂停，Group 2组有33例（66.00%）患者在麻醉诱导后出现呼吸暂停，差异无统计学意义（χ2=0.981，P=0.612）。结论麻醉诱导期间，依托咪酯较丙泊酚具有较好的血压及心率稳定性，不易诱发注射疼痛，对于血压及心率不稳定的患者是一个较理想的麻醉诱导制剂。

Objectives To explore the effects ofpropofol and etomidate on hemodynamics and adverse reactions in patients undertaking general anesthesia. Methods One-hundred-forty patients scheduled for elective laparoscopic cholecystectomy under general anesthesia from March, 2014 to Nov, 2015 were randomly divided into group 1, induced with propofol, and group 2, induced with etomidate. During induction, the blood pressures, heart rates, pain caused by injection, apnea, myoclonus, etc. in both groups were recorded. Results There were statistical differences in heart rate and mean arterial pressure at each time point between these two groups（F=158.341,201.276, P 〈 0.05）. 50.00% patients in group 1 and 96.00% in group 2 showed no pain caused by injection, with a statistical difference （Z=-2.143, P=-0.032）. All the patients in group 1 and 62.86% patients in group 2 showed no myoclonus, with a statistical difference （Z=-2.782, P=-0.028）. 76.00% patients in group 1 and 66.00% in the group 2 showed apnea after anesthesia induction, with a statistical difference （χ2=0.981, P=-0.612）. Conclusions Comparing with propofol, etomidate is better for its hemodynamic stability and has lower incidence of pain caused by injection. It is a better induction option for patients with hemodynamic fluctuation.