目的 探讨小剂量依托咪酯联合丙泊酚用于全麻诱导对血流动力学、麻醉深度的影响并观察其不良反应。方法 选择2018-10至2020-12解放军总医院第一医学中心择期行全麻手术患者90例,随机分为丙泊酚(A组)、依托咪酯(B组)、依托咪酯联合丙泊酚组(C组),每组30例。A组静脉注射丙泊酚2.0 mg/kg,B组静脉注射依托咪酯0.3 mg/kg,C组静脉注射依托咪酯0.075 mg/kg、丙泊酚1.0 mg/kg。诱导完成后行气管插管,观察记录诱导前(T0)、插管前(T1)、插管后1、3、5 min(T2-T4)3组患者平均动脉压(mean arterial pressure, MAP)、心率(heart rate,HR)及脑电双频指数(bispectral index, BIS)的变化,记录3组患者注射痛、肌阵挛、高血压、低血压、BIS<30等不良反应发生率。结果 C组诱导后的MAP高于A组(P<0.05),C组在T1-4时刻MAP高于A组,T2时刻MAP低于B组(P<0.05),且诱导后HR低于B组,T2时刻HR低于B组(P<0.05),BIS低于A组,T1时刻BIS高于B组,T2-3时刻低于A组,T4时刻低于A组,高于B组(P<0.05),注射痛和低血压发生率低于A组(0.0% vs. 36.7%,3.3% vs. 33.3%),肌阵挛发生率低于B组(3.3% vs. 66.7%),高血压、BIS<30发生率低于A、B组(3.3% vs. 40.0%、70.0%,0.0% vs. 30.0%、60.0%),差异均有统计学意义(P<0.05)。结论 预注射依托咪酯进行麻醉诱导,于插管前注射丙泊酚对全麻的血流动力学和麻醉深度影响小,不良反应发生率低。
Abstract
Objective To investigate the effects of low-dose etomidate combined with propofol as a means of general anesthesia induction and observe the changes of hemodynamics, the depth of anesthesia and adverse reactions. Methods Ninety patients scheduled for general anesthesia in our hospital between October 2018 and February 2020 were enrolled. These patients were randomly divided into three groups, with 30 patients in each. The methods of anesthesia induction included propofol 2.0 mg/kg in group A, etomidate 0.3 mg/kg in group B, and etomidate 0.075 mg/kg + propofol 1.0 mg/kg in group C. MAP, HR, BIS were measured respectively before induction (T0), before intubation(T1), and 1,3 and 5 minutes (T2-4) after intubation. Such adverse reactions as injection pain, myoclonus, hypertension, hypotension, and BIS<30 in each group were recorded. Results MAP in group C was higher than in group A at T1-4, but was lower than in group B at T2 (P<0.05). HR was lower in group C than in group B at T2 (P<0.05), BIS in group C was lower than in group A at T2-4, but was higher than in group B at T2 and T4(P<0.05). The incidence of injection pain and hypotension was lower in group C than in group A(0.0% vs. 36.7%,3.3% vs. 33.3%, P<0.05), so was the incidence of myoclonus(3.3% vs. 66.7%, P<0.05). The incidence of hypertension and BIS<30 was lower in group C than in group A and B(3.3% vs. 40.0%、70.0%,0.0% vs. 30.0%、60.0%, P<0.05). Conclusions After injection of etomidate for general anesthesia induction, propofol injected prior to tracheal intubation is a better agent for general anesthesia induction as evidenced by the stability of hemodynamics and the depth of anesthesia as well as lower incidence of adverse reactions.
关键词
丙泊酚 /
依托咪酯 /
全麻诱导 /
脑电双频指数
Key words
propofol /
etomidate /
general anesthesia induction /
bispectral index
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 赵丽云,徐铭军,朱 斌,等.心脏病患者非心脏手术围麻醉期中国专家临床管理共识(2020)[J].麻醉安全与质控,2021,5( 2):63-77.
[2] Hannam J A, Mitchell S J, Cumin D, et al. Haemodynamic profiles of etomidate vs propofol for induction of anaesthesia: a randomised controlled trial in patients undergoing cardiac surgery[J]. Br J Anaesth, 2019, 122(2):198-205.
[3] Devlin R J, Kalil D. Etomidate as an induction agent in sepsis[J]. Crit Care Nurs Clin North Am,2018,30(3):e1-9.
[4] Jeon Y. Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine[J]. J Anesth, 2012, 26(5):728-731.
[5] Dutta A, Sethi N, Sood J, et al. The effect of dexmedetomidine on propofol requirements during anesthesia administered by bispectral index-guided closed-loop anesthesia delivery system: a randomized controlled study[J]. Anesth Analg,2019, 129(1):84-91.
[6] Abou M H, Rostrup M, Heier T. Dose requirements of alfentanil to eliminate autonomic responses during rapid-sequence induction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg[J]. J Clin Anesth,2016, 35:465-474.
[7] Hao L, Hu X, Zhu B, et al. Clinical observation of the combined use of propofol and etomidate in painless gastroscopy[J]. Medicine (Baltimore),2020, 99(45):e23061.
[8] Soleimani A, Heidari N, Habibi M R, et al. Comparing hemodynamic responses to diazepam, propofol and etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery: a double-blind, randomized clinical trial[J]. Med Arch,2017, 71(3):198-203.
[9] 沈 浩,高雪莹,曹江北,等.依托咪酯持续输注对患者术后生化指标的影响[J].临床麻醉学杂志,2019,35(10):995-998.
[10] Zhu Y, Yang Y, Zhou C, et al. Using dezocine to prevent etomidate-induced myoclonus: a meta-analysis of randomized trials[J]. Drug Des Devel Ther,2017,11,2163-2170.
[11] Yagan Ö, Taş N, Küçük A, et al. Haemodynamic responses to tracheal intubation using propofol, etomidate and etomidate-propofol combination in anaesthesia induction[J].Cardiovasc Thorac Res,2015,7(4):134-140.
[12] Chen L, Liang X, Tan X, et al. Safety and efficacy of combined use of propofol and etomidate for sedation during gastroscopy: Systematic review and meta-analysis[J]. Medicine (Baltimore), 2019, 98(20): e15712.
[13] 王景华,王 璇,王小鹏,等.无痛胃肠镜检查中应用依托咪酯-丙泊酚混合液的麻醉效果[J].武警医学,2020,31( 8):688-691.
[14] Ye L, Xiao X, Zhu L. The comparison of etomidate and propofol anesthesia in patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis[J]. Surg Laparosc Endosc Percutan Tech,2017, 27(1):1-7.
[15] Liu Y H, Qiu D J, Jia L, et al. Depth of anesthesia measured by bispectral index and postoperative mortality: a meta-analysis of observational studies[J]. J Clin Anesth, 2019, 56:119-125.
[16] 林博浩,罗天元,喻 田,等.以GABAA受体为靶点的麻醉和镇静药的应用进展[J].临床麻醉学杂志,2020,36(3):304-307.
[17] Kent D E, Savechenkov P Y, Bruzik K S, et al. Binding site location on GABAA receptors determines whether mixtures of intravenous general anaesthetics interact synergistically or additively in vivo[J]. Br J Pharmacol, 2019, 176(24):4760-4772.
[18] Wang W, Lv J, Wang Q, et al. Oxycodone for prevention of etomidate-induced myoclonus: a randomized double-blind controlled trial[J]. Int Med Res,2018, 46(5):1839-1845.
[19] Yates A M, Wolfson A B, Shum L, et al. A descriptive study of myoclonus associated with etomidate procedural sedation in the ED [J]. Am J Emerg Med, 2013, 31(5):852-854.
[20] 李 杰,顾 冰,毛广婷,等.脑电双频指数监测下不同麻醉深度对老年患者术后早期认知功能影响的Meta分析[J].中国老年学杂志,2020,40(5):992-997.
[21] Zhou Y, Li Y, Wang K. Bispectral index monitoring during anesthesia promotes early postoperative recovery of cognitive function and reduces acute delirium in elderly patients with colon carcinoma: a prospective controlled study using the attention network test[J]. Med Sci Monit,2018, 24:7785-7793.
[22] Kent D E, Savechenkov P Y, Bruzik K S, et al. Binding site location on GABAA receptors determines whether mixtures of intravenous general anaesthetics interact synergistically or additively in vivo[J]. Br J Pharmacol, 2019, 176(24):4760-4772.
PDF(597 KB)
