靶控输注依托咪酯和瑞芬太尼对非心脏手术患者麻醉效果及血流动力学影响的比较

Comparison of influence of target controlled infusion of etomidate and remifentanyl on anesthetic effect and hemodynamics in patients with non-cardiac surgery

目的探究分析靶控输注(TCI)依托咪酯和瑞芬太尼对非心脏手术患者麻醉效果及血流动力学的影响。方法回顾性分析2013年6月至2015年6月接受非心脏手术治疗的110例手术患者临床资料,分为对照组(48例)和研究组(62例)。对照组采用脑电双频谱指数(BIS)指导TCI丙泊酚复合瑞芬太尼麻醉方案;研究组采用BIS指导TCI依托咪酯复合瑞芬太尼方案,比较两组临床麻醉情况。结果对照组术中血管活性药物使用率(33.33%)高于研究组(8.06%),差异有统计学意义(P<0.05)。两组苏醒时间、导管拔出时间比较,差异无统计学意义(P>0.05);研究组瑞芬太尼用量多于对照组,差异有统计学意义(P<0.01)。两组T2~T4时间段血流动力学指标水平较T0、T1时间发生明显变化,差异均有统计学意义(P<0.05)。对照组不良事件总发生率(12.50%)低于研究组(29.03%),差异有统计学意义(P<0.05)。结论 BIS指导TCI依托咪酯复合瑞芬太尼在非心脏手术中麻醉效果良好,且血流动力学较TCI丙泊酚复合瑞芬太尼麻醉稳定,但是不良事件发生率较高。

Objeetive To explore and analyze the influence of target controlled infusion （TCI） of etomidate and remifentanil on anesthet- ic effect and hemodynamics in the patients with non-cardiac surgery. Methods The clinical data in 110 patients receiving noncardiac surgery from June 2013 to June 2015 were retrospectively analyzed. The patients were divided into the control group （n=48） and study group （n= 62）. The control group adopted the bispectral index （BIS） for guiding TCI propofol combined with remifentanit anesthesia scheme; the study group adopted BIS guiding TCI etomidate combined with remifentanil. The clinical anesthesia situation was compared between the two groups. Results The use rate of vasoactive drugs in the control group was 33.33%, which was higher than 8.06% in the study group, and the difference was statistically significant （P〈0.05）. There was no statistically significant difference between the two groups in the recov- ery time and extubation time （P〉0.05）. The remifentanil dosage in the study group was higher than that in the control group, and the difference was statistically significant （P〈0.01）. The hemodynamic indexes levels at T2-T4 had more significant change than that at T0, T1, the difference was statistically significant （P〈0.05）. The incidence rate of adverse events in the control group was 12.50%, which was lower than 29.03% in the study group,and the difference was statistically significant （P〈0.05）. Conclusion BIS guiding TCI of etomidate combined with remifentanil has better introperative anesthetic effect, moreover the hemodynamics is more stable than TCI of propofol combined with remifentanil,but the incidence rate of adverse events is higher.