不同速度输注依托咪酯对老年患者麻醉诱导期肌阵挛的影响

Effect of Different Etomidate Infusion Speed on Etomidate-Induced Myoclonus in Elderly Partents

目的观察麻醉诱导期以不同速度输注依托咪酯对老年患者肌阵挛的影响。方法选择2015年12月至2016年12月于无锡市人民医院择期行全身麻醉手术老年患者共150例,其中男74例,女76例,年龄65~80岁,ASA分级Ⅱ~Ⅲ级,在麻醉诱导期单独恒速静脉输注0.2 mg/kg依托咪酯脂肪乳注射液。随机分为3组,每组50例。A组输注速度为0.2 mg/(kg·min);B组输注速度为0.27 mg/(kg·min);C组输注速度为0.4 mg/(kg·min)。记录各组在静脉输注药物即刻(T0),停止输注药物后1 min(T1)和2 min(T2)的平均动脉压(MAP)、心率(HR)、经皮脉搏氧饱和度(SpO_2)、脑电双频谱指数(BIS);观察输注剂量、输注时间及在T0至T2期间是否发生肌阵挛及其肌阵挛级别。观察完毕后给予静脉注射舒芬太尼0.4μg/kg和顺式阿曲库铵0.2 mg/kg,待肌松后行气管内插管。结果 3组肌阵挛的发生率分别为28%、40%、70%。A组肌阵挛的发生率明显低于B组和C组(P<0.05)。HR和SpO_2值在组间和组内各时点比较,差异均无统计学意义(P>0.05)。与T0比较,3组MAP值在T1、T2各点均下降(P<0.05),且随速度增加降低程度明显。3组BIS值在各时点比较,差异无统计学意义(P>0.05),且3组输注速度均能在麻醉诱导期达到理想的麻醉深度(BIS值为40~60)。结论以0.2 mg/(kg·min)的速度输注依托咪酯脂肪乳剂可显著降低诱导期肌阵挛的发生率,并可获得相对稳定的血流动力学变化且无明显呼吸抑制。

ObjectiveTo investigate the clinical effect of different etomidate infusion speed on etomidate-induced myoclonus during anesthesia induction for elderly patients. Methods150 cases of patients （ASA physical status Ⅱ-Ⅲ） under general anesthesia from December 2015 to December 2016, including 74 males and 76 females, aged 65 to 80 years, were randomly assigned to 3 groups based on the etomidate infusion speed during anesthesia induction： group A[0.2 mg/（kg·min）], group B [0.27 mg/（kg·min）], group C [0.4 mg/（kg·min）]. All 3 groups patients receive etomidate （0.2 mg/kg） with the setting speed. MAP, HR, SpO2, BIS were meastured at the time of infusion （T0）, one minute after the end of infusion （T1）, two minutes after the end of infusion （T2）. Myoclonic movements are evaluated which were observed and graded according to clinical severity during the whole anesthesia induction. The infusion doses and infusion time of etomidate were recorded. Patients received sufentanil （0.4 μg/kg） and cis-atracurium （0.2 mg/kg） and the endotracheal intubation was operated after muscle relaxant. ResultsThe results showed that the incidence of myoclonus was 28%,40%,70% in group A, group B, group C respectively. Compared with group B and group C, group A had significantly lower positive incidences（P〈0.05）. However, there were no significant difference in HR and SpO2 in three groups and in different times（P〉0.05）. There was significant different in MAP changes in each group （P〈0.05）. The faster etomidate infused, the lower MAP were. Also, there was no statistical significance of BIS between 3 groups. what’s more, each patient could achieve ideal depth of anesthesia（BIS between 40 and 60）. ConclusionWith 0.2 mg/（kg·min） infusion speed of etomidate may reduce the incidences and scales of etomidate-induced myoclonus in elderly patients during anesthesia induction. What’ more, this speed can acquire more stable hemodynamic changes and no obvious apnea.