丙泊酚联合依托咪酯麻醉对卵巢癌患者麻醉诱导时血流动力学的影响

Effect of propofol combined with etomidate anesthesia on hemodynamics during anesthesia induction in patients with ovarian cancer

目的研究丙泊酚联合依托咪酯麻醉对卵巢癌患者麻醉诱导时血流动力学的影响。方法 90例卵巢癌手术患者,按麻醉诱导方案不同分为丙泊酚组、依托咪酯组、联合组,每组30例。丙泊酚组采用丙泊酚麻醉诱导,依托咪酯组采用依托咪酯麻醉诱导,联合组采用丙泊酚联合依托咪酯麻醉诱导。比较三组患者麻醉诱导期不同时间点[诱导前(T0)、插管前1 min(T1)、插管即刻(T2)、插管后1 min(T3)、插管后5 min(T4)]的舒张压(DBP)、收缩压(SBP)及心率(HR)变化情况及气管插管条件Coopers评分、肌电活动指数(EMG)、肌松效应起效时间。结果 T0、T1时,三组患者DBP、SBP及HR对比差异无统计学意义(P>0.05);T2、T3、T4时,联合组、依托咪酯组DBP、SBP及HR明显高于丙泊酚组,差异具有统计学意义(P<0.05);T3、T4时,联合组DBP、SBP及HR明显低于依托咪酯组,差异具有统计学意义(P<0.05)。三组患者Coopers评分比较差异无统计学意义(P>0.05);联合组、依托咪酯组患者EMG(6.20±1.89)、(6.23±2.20)低于丙泊酚组的(15.74±2.22);肌松效应起效时间(100.1±25.4)、(97.8±23.6)s短于丙泊酚组的(120.9±22.7)s,差异具有统计学意义(P<0.05)。结论在卵巢癌患者麻醉诱导期采用丙泊酚联合依托咪酯麻醉效果尤为显著,能够加快患者的肌松效应,在确保插管效果基础上不会过多影响到血流动力学,在临床上具有应用价值。

Objective To study the effect of propofol combined with etomidate anesthesia on hemodynamics during anesthesia induction of patients with ovarian cancer.Methods A total of 90 patients with ovarian cancer were divided into propofol group,etomidate group and combination group according to different regimens of anesthesia induction,with 30 cases in each group.The propofol group was induced with propofol anesthesia,the etomidate group was induced with etomidate anesthesia,and the combination group was induced with propofol combined with etomidate anesthesia.The diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR)changes at different time points of anesthesia induction[before induction(T0),1 min before intubation(T1),immediately after intubation(T2),1 min after intubation(T3),5 min after intubation(T4)],tracheal intubation conditions Coopers score,electromyographic avtivity(EMG),onset time of muscle relaxation effect of the three groups were compared.Results At T0 and T0,there was no statistically significant difference in DBP,SBP and HR among the three groups(P>0.05).At T2,T3 and T4,DBP,SBP and HR of combination group and etomidate group was obviously higher than that of propofol group,and the difference was statistically significant(P<0.05).At T3 and T4,DBP,SBP and HR of combination group was obviously lower than that of etomidate group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in Coopers score among three groups(P>0.05).EMG(6.20±1.89),(6.23±2.20)of combination group and etomidate group was lower than that of propofol group(15.74±2.22),and onset time of muscle relaxation effect(100.1±25.4),(97.8±23.6)s was shorter than that of propofol group(120.9±22.7)s,and the difference was statistically significant(P<0.05).Conclusion The anesthesia effect of propofol combined with etomidate in the anesthesia induction period of patients with ovarian cancer is particularly significant,which can accelerate the muscle relaxation effect of the patient,and ensure the effect of intubation without excessively affecting hemodynamics.It has application value in clinic.