摘要
目的探讨依托咪酯乳剂复合瑞芬太尼在全凭静脉麻醉中应用的可行性。方法选择80例ASAI、II拟行腹部手术患者,随机分为依托咪酯组(E组n=40)和丙泊酚组(P组n=40),两组病人麻醉诱导一致,E组的依托咪酯乳剂的维持剂量为10￣15μg/(kg·min),P组的丙泊酚的维持剂量为6￣10mg/(kg·h)。两组病人均复合瑞芬太尼泵注。分别于麻醉前、切皮后5min、探查后10min、病灶切下后10min、拔气管导管后10min、术后2、24h观察心血管反应、血浆皮质醇、血糖的变化以及苏醒的情况。结果两组病人术中血流动力学均维持稳定,两组病人术中血糖变化随着手术进程逐渐增高,P组病人血浆皮质醇的变化与血糖一致,而E组病人术中血浆皮质醇水平虽逐渐降低,但维持在正常范围,且术后24h恢复至术前水平。术毕苏醒时间,P组明显短于E组。结论依托咪酯对肾上腺皮质的抑制作用是短暂的,可安全用于无肾上腺皮质功能减退的病人的全凭静脉麻醉。
[Objective] To discuss the possibility of the application etomidate and remifentanil in total intravenous anesthesia （TIVA）. [Methods] Eighty patients scheduled for operation on abdominal region were divided into two groups of 40 each： etomidate group （group E） and propofol group （group P）. The two groups have the same anesthesia induction, The patients in group E was maintained with 10-15μg/（kg·min） etomidate, and the patients in group P was maintained with 6-10 mg/（kg·h） propofol. The both groups were combined with remifentanil. Observed eardiovascualar effects, changes of plasma eortisel and glucose concentration before anesthesia, 5 min after cutting skin, 10 rain after exploration, 10 rain after cutting ill focus, 10 min after tracheal extubation, 2 h and 24 h after opelation. At same time, observed analepsia condition. [Results] Both groups have same stabilized hemodynamies. The glucose concentration in two groups increased gradually, the changes of plasma eortisel in group P is same as that of glucose concentration, however in group E, although the plasma eortisol concentration decreased gradually but maintain normal range and recovered preoperative level next day. The time of analepsia in group E is longer than that in group P. [Conclusions] The inhibition of etomidate on the function of the adrenal cortex is temporal and safe for TIVA of those who are not hypoadrenocortieism.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2006年第15期2350-2352,共3页
China Journal of Modern Medicine
