比较异丙酚和依托咪酯诱导麻醉下喉镜检查和气管插管时的心血管反应

发布时间：2018-11-25 19:34

【摘要】：目的：依托咪酯和异丙酚是常用的静脉麻醉药。二者都属于非巴比妥类镇静药。异丙酚又名丙泊酚（propofol）,它是一种静脉麻醉药，具有快效短效苏醒迅速而完全及持续输注后无蓄积的特点。现如今异丙酚普遍用于麻醉诱导和麻醉维持，药物常用于麻醉中，手术后和ICU病房的镇静。依托咪酯（etomidate）在1964年被合成，在1972年被推荐用于临床。这种药为咪唑类衍生物，是催眠性镇静麻醉药，麻醉诱导和苏醒较快，相对安全，故临床应用较多。随着全麻患者的日益增多，气管插管可以为手术期间提供一个安全气道，另外喉镜检查也日益增多。气管插管和喉镜检查最重要的副作用包括心血管反应。先前的研究认为依托咪酯可以用于血流动力学储备有限的的患者，而异丙酚会导致更多的血流动力学不稳定。本研究探讨在烧伤患者手术时用依托咪酯和异丙酚麻醉诱导，对患者的心血管反应进行比较。材料和方法：我们选择了包括年龄在19-62岁之间的50例烧伤病人，50名烧伤患者的性别构成是33名男性，17名女性。患者体重在51kg至86kg之间。患者否认高血压、脑梗、心肝肾功能不全、糖尿病、肾上腺疾病史，没有长期应用大剂量糖皮质激素治疗。他们是2013年不幸被烧伤的患者，烧伤深度是II度-III度，烧伤面积为35%-70%。这些患者头面部有不同程度的烧伤，但均没有精神障碍和严重的呼吸道损伤，这50名患者没有麻醉药过敏史。患者ASAI级（美国麻醉医师协会），手术前对病人病史和一般情况进行评估，对一般资料例如患者性别、年龄、体重及体重指数进行了解，常规检查患者的血常规、尿常规、肝肾功能、电解质、常规心电图、胸片。两组患者参与实验，在手术之前按照常规进行禁食8小时，禁饮4小时，阿托品0.5mg术前30分钟肌注，苯巴比妥钠100mg术前30分钟肌注。病人被随机分成两组，A组用依托咪酯（0.3mg/kg），B组用异丙酚（2-2.5mg/kg），观察他们在喉镜检查前和麻醉诱导后的1分钟，3分钟，5分钟，10分钟的心血管反应，观察的心血管反应指标包括：收缩压（SBP），舒张压（DBP），平均动脉压（MAP），心率（HR）和血氧饱和度（SPO2）。结果：两组在性别，年龄，，体重指数和喉镜检查的困难程度上没有明显的统计学差异（P0.05）。但是B组的收缩压明显提高(P=0.019)，此外B组的舒张压也明显提高(P=0.001)，平均动脉压B组也变高(P=0.008)。而低血压的发生率在B组达到26.1%，在A组是8%（P=0.09）。A组和B组在心率方面（P=0.47），血氧饱和度方面（P=0.21），心动过速（P=0.6）和心动过缓方面（P=0.66）没有明显的差异。结论：病人接受依托咪酯有更稳定的血流动力学状态，收缩压（SBP），舒张压（DBP），平均动脉压（MAP）平稳，可以减轻患者的心血管反应，因此如果没有禁忌症，可以优先于异丙酚用于喉镜检查，气管插管全身麻醉。依托咪酯用于喉镜检查和麻醉诱导气管插管相对安全，便捷，对于烧伤患者和心血管患者是理想用药。
[Abstract]:Objective: etomidate and propofol are common intravenous anesthetics. Both belong to non-barbiturates. Propofol, also known as propofol (propofol), (propofol), is an intravenous anesthetic with the characteristics of quick and short effect recovery, complete and no accumulation after continuous infusion. Propofol is now widely used in anesthesia induction and maintenance, and in anesthesia, after surgery, and in ICU ward sedation. Etomidate (etomidate) was synthesized in 1964 and recommended for clinical use in 1972. This drug is a derivative of imidazole, hypnotic sedation anesthetic, anesthesia induction and recovery faster, relatively safe, so clinical application is more. With the increasing number of patients with general anesthesia, tracheal intubation can provide a safe airway during surgery, and laryngoscopy is also increasing. The most important side effects of tracheal intubation and laryngoscopy include cardiovascular reactions. Previous studies have suggested that etomidate can be used in patients with limited hemodynamic reserves, while propofol leads to more hemodynamic instability. The aim of this study was to investigate the cardiovascular response of burn patients induced by etomidate and propofol. Materials and methods: we selected 50 burn patients aged between 19 and 62. The gender composition of 50 burn patients was 33 males and 17 females. The patient's weight ranged from 51kg to 86kg. Patients denied hypertension, cerebral infarction, heart, liver and kidney dysfunction, diabetes, history of adrenal disease, and no long-term use of high-dose glucocorticoids. They were patients with unfortunate burns in 2013. The burn depth was II-III, and the burn area was 35-70. The patients had varying degrees of burns on the head and face, but no mental disorders and severe respiratory injuries. The 50 patients had no history of anaesthetic allergy. ASAI (American Association of Anesthesiologists), who assess the patient's history and general situation before surgery, understand general data such as gender, age, body mass and body mass index, routinely examine the patient's blood routine and urine routine, Liver and kidney function, electrolyte, routine electrocardiogram, chest radiography. The two groups of patients participated in the experiment, fasting 8 hours before operation, forbidding 4 hours, atropine 0.5mg 30 minutes before intramuscular injection, phenobarbital sodium 100mg 30 minutes before intramuscular injection. Patients were randomly divided into two groups: group A received etomidate (0.3mg/kg), B group) with propofol (2-2.5mg/kg), and they were observed before laryngoscopy and 1, 3, 5 minutes after anesthesia induction. After 10 minutes of cardiovascular response, systolic pressure, (SBP), diastolic blood pressure, (DBP), mean arterial pressure, (MAP), (HR), and blood oxygen saturation (SPO2) were observed. Results: there was no significant difference in sex, age, BMI and laryngoscopy between the two groups (P0.05). But the systolic blood pressure in group B was significantly increased (P0. 019), the diastolic blood pressure in group B was also significantly increased (P0. 001), and the mean arterial pressure in group B was higher (P0. 008). The incidence of hypotension was 26.1% in group B, 8% in group A (P0. 09). A and group B) in heart rate (P0. 47), and in saturation of blood oxygen (P0. 21). There was no significant difference in tachycardia (P 0. 6) and bradycardia (P 0. 66). Conclusion: patients receiving etomidate have a more stable hemodynamic state, systolic (SBP), diastolic blood pressure (DBP),) mean arterial pressure (MAP) is stable, which can alleviate the cardiovascular response of patients, so if there is no contraindication, It can take precedence over propofol for laryngoscopy, tracheal intubation and general anesthesia. Etomidate is relatively safe and convenient for laryngoscopy and anesthesia induction tracheal intubation. It is an ideal drug for burn patients and cardiovascular patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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