依托咪酯复合丙泊酚在腹腔镜胆囊切除术中的应用

发布时间：2018-05-23 13:36

本文选题：依托咪酯 + 丙泊酚　；参考：《临床麻醉学杂志》2017年11期

【摘要】：目的观察依托咪酯复合丙泊酚诱导用于腹腔镜胆囊切除术的临床效果。方法选择2015年3月至2016年4月在我院行腹腔镜胆囊切除术的患者80例,男44例,女36例,ASAⅠ或Ⅱ级。按随机数表法均分为四组,每组20例。A组:静注丙泊酚2 mg/kg;B组:静注依托咪酯0.3mg/kg;C组静注依托咪酯0.15mg/kg、丙泊酚1mg/kg;D组静注依托咪酯0.1mg/kg、丙泊酚1.5mg/kg。麻醉诱导完成后行快速气管内插管。观察和记录麻醉诱导给药前(T0)、插管前1 min(T_1)、插管时(T_2)、插管后1min(T_3)、插管后5min(T_4)、插管后15min(T_5)四组患者的HR、BP;采集四组在T0、麻醉诱导后30min(Tb)、麻醉诱导后2h(Tc)、麻醉诱导后24h(Td)的静脉血,离心后取血清,采用放射性免疫法测血清中的皮质醇(Cor)、醛固酮(ALD)以及促肾上腺皮质激素(ACTH);记录并比较四组患者诱导时注射痛、肌阵挛及术后恶心呕吐等不良反应的发生率。结果与T0时比较,T_1、T_4、T_5时A组,T_1、T_5时D组HR明显减慢(P0.05);T_1、T_4、T_5时A组,T_1、T_5时C组,T_1、T_5时D组SBP明显降低,T_2时B组SBP明显升高(P0.05)。与T0时比较,Tb、Tc时B、C组Cor、ALD明显降低,Tb、Tc时B组,Tc时C组ACTH明显升高(P0.05);Tb、Tc时B、C组Cor、ALD明显低于A组,Td时B、C组ALD明显高于A组(P0.05);Tb时C组ACTH明显高于A组(P0.05);Tb、Tc时C、D组Cor、ALD明显高于B组(P0.05);Tb、Tc时D组Cor、ALD明显高于C组(P0.05)。结论依托咪酯复合丙泊酚诱导可减轻单纯丙泊酚或单纯依托咪酯诱导时的应激反应,是一种值得推广的麻醉诱导方式。
[Abstract]:Objective to observe the clinical effect of etomidate combined with propofol in laparoscopic cholecystectomy. Methods from March 2015 to April 2016, 80 patients (44 males and 36 females) underwent laparoscopic cholecystectomy in our hospital. Each group (n = 20) was divided into four groups: group A (n = 20): intravenous injection of propofol (2 mg / kg): group B: intravenous injection of etomidate (0.3 mg / kg), intravenous injection of etomidate (0.15 mg / kg), propofol (1 mg / kg / kg D), intravenous injection of etomidate (0.1 mg / kg), propofol (1.5 mg / kg). Rapid endotracheal intubation was performed after anesthesia induction. HRBPs were observed and recorded before anesthesia induction administration, 1 minute before intubation, 1 minute after intubation, 1 min after intubation, 5 min after intubation and 15 min after intubation, respectively. Serum cortisol cortisone aldosterone (ALD) and adrenocorticotropic hormone (ACTH) were measured by radioimmunoassay and the incidence of adverse reactions such as injection pain myoclonus postoperative nausea and vomiting were recorded and compared among the four groups. Results compared with T _ 0, the HR of group A and T _ (1) T _ (5) were significantly slower than that of T _ (1) / T _ (5). The HR of group D was significantly lower than that of T _ (1) T _ (1) T _ (4) T _ (5) T _ (5). The SBP of group D was significantly lower than that of T _ (1) T _ (5). The SBP of group B was significantly lower than that of group B (P 0.05) at T _ (1) T _ (5) and T _ (1) T _ (4) T _ (5) at T _ 1 / T _ (5). Compared with T0, ALD in group C was significantly lower than that in group B at T0. The level of ACTH in group C was significantly higher than that in group B at TBC. The level of ALD in group C was significantly lower than that in group A (group A). The ACTH in group C was significantly higher than that in group C (group A, P 0.05Tc). The ACTH in group C was significantly higher than that in group C (group B). The ALD of group D was significantly higher than that of group C (P 0.05). Conclusion Etomidate combined with propofol can reduce the stress response induced by propofol or etomidate alone, and it is worth popularizing.
【作者单位】：湖北省荆门市第一人民医院麻醉科;
【基金】：湖北省荆门市科技局一般项目(YFYB2015011)
【分类号】：R614

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