丙泊酚联合依托咪酯用于减重手术中对血流动力学及应激反应的影响

Effect of propofol combined with etomidate on hemodynamics and stress response during weight loss surgery

目的基于血流动力学、应激反应观察减重手术中应用丙泊酚联合依托咪酯的价值。方法回顾性选取2020年1月至2021年1月山西白求恩医院收治的接受减重手术的患者,根据术中麻醉方案的不同分为试验组(丙泊酚联合依托咪酯)和对照组(丙泊酚)。记录患者的手术时间、苏醒时间、拔管时间、血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]、应激指标[促肾上腺皮质激素(ACTH)、肾上腺素(ADR)、皮质醇(COR)]、简易智力状态检查量表(MMSE)评分和不良反应。结果研究共纳入患者80例,试验组47例,对照组33例。两组手术时间、苏醒时间、拔管时间差异无统计学意义(P>0.05)。插管后即刻试验组HR、MAP低于对照组,SpO_(2)高于对照组(P<0.05)。试验组插管后即刻、拔管后5 min血清ACTH、ADR、COR水平低于对照组(P<0.05)。苏醒后10min试验组MMSE评分高于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论减重手术中采用丙泊酚联合依托咪酯可减小血流动力学波动、减轻认知功能损害,可减轻应激反应,且未明显增加麻醉不良反应,安全性较好。

Objective To observe the value of propofol combined with etomidate in bariatric surgery based on hemodynamics and stress response.Methods Patients admitted to Shanxi Bethune Hospital who underwent bariatric surgery from January 2020 to January 2021 were retrospectively selected and divided into an experimental group(propofol combined with etomidate)and a control group(propofol)according to the intraoperative anesthesia regimen.The patient's surgical time,awakening time,extubation time,hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2))],stress indicators[adrenocorticotropic hormone(ACTH),adrenaline(ADR),cortisol(COR)],Mini Mental State Examination(MMSE)score,and adverse reactions were recorded.Results A total of 80 patients were included in the study,among which 47 cases were in the experimental group,and 33 cases were in the control group.There was no statistically significant difference in operation time,awakening time and extubation time between the two groups(P>0.05).Immediately after intubation,HR and MAP of the experimental group were lower than those of the control group,and SpO_(2) was higher than that of the control group(P<0.05).Serum ACTH,ADR and COR levels in the experimental group were higher than those in the control group immediately after intubation and 5 min after extubation(P<0.05).The MMSE score of the experimental group 10 min after awakening was higher than that of the control group(P<0.05).The difference in the incidence of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion The use of propofol combined with etomidate in weight loss surgery can reduce hemodynamic fluctuations,alleviate cognitive impairment,alleviate stress reactions,and does not significantly increase anesthesia adverse reactions,which is with good safety.