依托咪酯联合丙泊酚麻醉对耳鼻喉科手术患者血流动力学的影响

Study on the effect of BIS guided anesthesia with etomidate combined propofol on hemodynamics of ENT patients

目的观察依托咪酯联合丙泊酚麻醉对耳鼻喉科手术患者血流动力学的影响。方法选择60例20~60岁、ASAⅠ~Ⅱ级耳鼻喉科手术患者,随机分为三组:依托咪酯组(E组)采用依托咪酯诱导和维持麻醉,丙泊酚组(P组)采用丙泊酚诱导和维持麻醉,联合组(EP组)采用依托咪酯联合丙泊酚诱导和维持麻醉,所有患者均行全麻插管。观察三组在诱导前(T0)、插管前1min(T1)、插管即刻(T2)、插管后5 min(T3)、插管后15 min(T4)、插管后30 min(T5)、插管后60 min(T6)及手术结束(T7)时的血流动力学变化,并记录患者睁眼时间,拔管时间和恶心呕吐等不良反应发生情况。结果三组患者诱导前血流动力学指标差异均无统计学意义(P>0.05);E组在T2时间点的平均动脉压(MAP)和心率(HR)较T0时间点明显升高,且T2~T7时间点的MAP和HR显著高于P组和EP组;P组诱导时循环波动明显,T1~T7时间点的MAP和HR维持于较低水平;而EP组各时间点的血流动力学指标比较,差异均无统计学意义(P>0.05)。E组的睁眼时间和拔管时间长于P组和EP组(P<0.05),EP组不良反应的发生情况较E组和P组明显减少(P<0.05)。结论耳鼻喉科手术患者采用依托咪酯联合丙泊酚维持麻醉,有助于维持血流动力学平稳,减少不良反应,达到满意的麻醉效果,具有重要的临床价值。

Objective To explore the effect of anesthesia by application of etomidate combined with propofol on hemodynamics in patients undergoing ENT surgery under BIS monitoring. Methods 60 patients（ aged 20 ～ 60 years,ASA Ⅰ ～ Ⅱ） scheduled for ENT surgery were divided into 3 groups by using random number table： the anesthesia in patients of etomidate group（ group E） was induced and maintained by etomidate,that in patients of propofol group（ group P） was induced and maintained by propofol,and patients in combination group（ group EP） were induced and maintained by etomidate combined with propofol. All these patients received endotracheal intubation under general anesthesia. The changes in hemodynamics in patients of these 3 groups before induction（ T0）,1 min before intubation（ T1）,intubation（ T2）,5 min after intubation（ T3）,15 min after intubation（ T4）,30 min after intubation（ T5）,60 min after intubation（ T6） and the end of operation（ T7） were observed,the time for opening eyes,the time for extubation and the occurrence of adverse reactions such as nausea,vomiting etc were recorded. Results There was no significant difference in parameters of operative hemodynamics among these three groups. In comparison with the time point T0,the mean arterial pressure（ MAP） and heart rate（ HR） were significantly higher than those at T2. Moreover,in comparison with groups P and EP,MAP and HR in group E at T2 ～ T7 were much higher（ P〈0. 05）. Patients in group P experienced significant fluctuation in hemodynamics,and MAP and HR at T1 ～ T7 were maintained at a low level. There was no significant difference in hemodynamics at each time point of group EP（ P〈0. 05）. The time for opening eyes and extubation time of group E were longer than those of groups P and EP（ P〈0. 05）. The incidence rates of adverse events in group EP were significantly lower than those of groups E and P（ P〈0. 05）. Conclusion The application of etomidate combined with propofol in anesthesia regimen for patients with ENT surgery contributes to the stability of hemodynamics,less adverse events,achievement of satisfactory anesthetic effects,hence it has important clinical significance.