依托咪酯脂肪乳于全凭静脉麻醉的效果评价.docVIP

依托咪酯脂肪乳用于全凭静脉麻醉的效果评价 韩冲芳,屈天昉,聂丽霞 （山西医科大学第一医院 麻醉科，山西 太原 030001） 【摘要】目的：评价依托咪酯应用于全凭静脉麻醉诱导、维持的效果。方法：随机选取全凭静脉麻醉下手术患者78例做回顾性分析，ASAⅠ～Ⅱ级，分为依托咪酯组（E组n=40）和丙泊酚组（P组n=38）。麻醉诱导过程，两组患者均静注咪达唑仑0.03 mg/kg，稍后,E组给予依托咪酯0.5~0.6mg/kg缓慢静注,P组给予丙泊酚1.5~2.5mg/kg缓慢静注,两组同时复合瑞芬太尼1~1.5μg/kg、阿曲库铵0.15mg/kg，并观察此过程中患者出现肌阵挛和注射痛的情况。术中维持用药,E组：依托咪酯0.3~1.2mg/(kg.h)持续泵注,P组：丙泊酚6~12mg/(kg.h)持续泵注,两组均同时复合手术需要量瑞芬太尼持续泵注，阿曲库铵间断追加维持肌松。分别记录诱导前（T1）、插管时（T2）、切皮时（T3）、手术开始30分钟（T4）、拔管时（T5）、拔管后5分钟（T6）的舒张压、收缩压、心率值进行数据分析；同时观察麻醉过程中患者情况、苏醒情况并记录停药后唤醒时间、拔管时间、定向力恢复时间。数据记录结果以均数士标准差(±s)表示，采用SPSS 13.0统计学分析软件包处理，计量资料采用t检验，计数资料采用卡方检验，p 0.05为有统计学差异。结果：两组患者血流动力学稳定。麻醉诱导：E组血压、心率下降幅度明显小于P组，结果有统计学差异(p0.05)。术中维持：切皮时、手术开始30分钟组内比较，两组血压、心率均较低于诱导前，E组下降幅度小于P组，结果有统计学差异(p0.05)；两组患者在拔管时和拔管后5分钟循环系统参数较诱导前无显著差异，组间无显著差异(p0.05)。停药后，唤醒时间E组较P组长，有统计学差异(p0.05)；拔管时间及定向力恢复时间两组无统计学差异。个别患者出现诱导期肌阵挛和短暂局部注射痛。结论：依托咪酯脂肪乳用于全凭静脉麻醉诱导快速，平稳；术中维持对循环影响小，深度能够满足手术要求，效果满意，苏醒时间短、效果好。 【关键词】依托咪酯脂肪乳 丙泊酚 全凭静脉麻醉 Effectiveness of etomidate fat emulsion in total intravenous anesthesia Han chongfang, Qu tianfang，Nie lixia (Department of Anesthesiology, the First Hospital of Shanxi Taiyuan 【Abstract】Objective: To estimate the effectiveness of etomidate fat emulsion in induction and maintenance of total intravenous anesthesia (TIVA). Methods: 78 scheduled for operation with TIVA for retrospective analysis immediately. They were divided into two groups: etomidate group (group E, n=40) and propofol group (group P, n=38). Induction，group E：etomidate, remifentanil, atracurium; group P: propofol remifentanil, atracurium. The patients in group E was maintained with 0.3~1.2mg/ (kg.h) etomidate, and the patients in group P with 6~12mg/ (kg .h) propofol. The both groups were combined with remifentanil and atracurium. Observed cardiovascular effects, changes and record SBP, DBP, HR before anesthesia, instantly of intubate, instantly of cutting skin, 30 min after exploration, instantly of extubate and 5 min after extubate. At same time, observed analeptic co