腹腔镜下全子宫切除手术依托咪酯联合丙泊酚麻醉效果及安全性的量效分析

Dose-effect on the anesthetic effect and safety of etomidate combined with propofol of patients during laparoscopic total hysterectomy

目的:研究不同剂量依托咪酯联合丙泊酚对腹腔镜下全子宫切除手术麻醉效果及安全性。方法:纳入2019年1月-2022年3月本院收治的行腹腔镜下全子宫切除手术患者80例临床资料,根据丙泊酚+依托咪酯不同配比分为高剂量组(1.5 mg/kg丙泊酚+0.075 mg/kg依托咪酯,n=32)、中剂量组(1.0 mg/kg丙泊酚+0.15 mg/kg依托咪酯,n=23)和低剂量组(0.5 mg/kg丙泊酚+0.225 mg/kg依托咪酯,n=25)。比较麻醉后3组眼睑反射消失时间、苏醒时间、拔管时间;比较麻醉诱导前1 min(T0)、插管前(T1)、插管后1 min(T2)、插管后3 min(T3)、插管后5 min(T4)心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)及不良事件发生率。结果:低剂量组眼睑反射消失时间(1.94±0.28 min)长于高剂量组(1.70±0.24 min)和中剂量组(1.94±0.28 min)(P<0.05);3组苏醒时间、拔管时间、各时间点HR无差异(P>0.05);T2、T3时MAP高剂量组(84.80±9.17 mmHg、69.94±6.52 mmHg)低于低剂量组(93.46±8.12 mmHg、76.05±6.44 mmHg)(P<0.05),其他时点3组MAP无差异(P>0.05);T0、T1时3组BIS无差异(P>0.05),T2~T4时高剂量组BIS最高(P<0.05);肌阵挛发生率高剂量组(25.0%)低于低剂量组(60.0%)(P<0.05),其他不良事件3组无差异(P>0.05)。结论:1.5 mg/kg丙泊酚+0.075 mg/kg依托咪酯在腹腔镜下全子宫切除手术中的麻醉效果更理想,可维持血流动力学平衡,且不良事件发生概率更低。

Objective:To study the anesthetic effect and safety of the different dosages of etomidate combined with propofol of patients during laparoscopic total hysterectomy.Methods:The clinical data of 80 patients who had accepted laparoscopic total hysterectomy in the hospital from January 2019 to March 2022 were selected in this study.According to the different ratios of propofol and etomidate,these patients were divided into group A(32 patients with 1.5 mg/kg propofol and 0.075 mg/kg etomidate),group B(23 patients with 1.0 mg/kg propofol and 0.15 mg/kg etomidate)and group C(25 patients with 0.5 mg/kg propofol and 0.225 mg/kg etomidate).The disappearance time of eyelid reflex,the awakening time and the extubation time of the patients were compared among the three groups.The values of heart rate,mean arterial pressure(MAP)and bispectral index(BIS)of the patients at 1 min before anesthesia induction(T0),before intubation(T1),at 1 min after intubation(T2),at 3 min after intubation(T3)and at 5 min after intubation(T4),and the incidence of adverse events of the patients were compared among the three groups.Results:The disappearance time of eyelid reflex(1.94±0.28 min)of the patients in group C was significantly longer than that(1.70±0.24 min)of the patients in group A and that(1.94±0.28 min)of the patients in group B(P<0.05).There were no significant differences in the recovery time,the extubation time and the HR value of the patients in different time point among the three groups(P>0.05).The MAP value of the patients in group A at T2 and at T3(84.80±9.17 mmHg and 69.94±6.52 mmHg)were significantly lower than those(93.46±8.12 mmHg and 76.05±6.44 mmHg)of the patients in group C(P<0.05),and there were no significant difference in the MAP value of the patients at T0,T1 and T4 among the three groups(P>0.05).There was no significant difference in the BIS value of the patients at T0 and T1among the three groups(P>0.05),and the BIS value of the patients in group A at T2-T4 was the highest(P<0.05).The incidence of myoclonus(25.0%)of the patients in group A was significantly lower than that(60.0%)of the patients in group C(P<0.05).There was no significant difference in the other adverse events rate of the patients among the three groups(P>0.05).Conclusion:The anesthetic effect of 1.5 mg/kg propofol and 0.075 mg/kg etomidate used during laparoscopic total hysterectomy of the patients is more ideal,which can maintain their hemodynamic balance,and with the lower probability of the adverse events.