摘要
目的评价依托咪酯靶控输注（TCI）复合瑞芬太尼用于妇科腹腔镜手术病人麻醉的效果。方法择期行妇科腹腔镜手术病人60例，年龄25～56岁，体重指数18～27kg／m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其分为2组（n=30）：TCI丙泊酚复合瑞芬太尼麻醉组（PR组）和TCI依托咪酯复合瑞芬太尼麻醉组（ER组）。2组静脉注射咪达唑仑0．1mg／kg、芬太尼4μg／kg和顺阿曲库铵0．15mg／kg麻醉诱导，PR组TCI丙泊酚，效应室靶浓度（Ce）2．5μg／ml，ER组TCI依托咪酯，Ce0．8μg／ml，气管插管后行机械通气。麻醉维持：PR组TCI丙泊酚，Ce2．0～2．5μg/ml，ER组TCI依托咪酯，Ce0．5～0．7μg／ml，2组静脉输注瑞芬太尼0．1～0．2μg·kg-1·min-1，间断静脉注射顺阿曲库铵5mg，维持BIS值40～60。分别于术前（基础状态，T0）、术毕（T1）、术后24h（T2）和术后48h（T3）时采集静脉血样，测定血清皮质醇和醛固酮的浓度；记录苏醒时间、拔除气管导管时间和术中血管活性药物使用情况；记录麻醉诱导时注射痛和肌颤、术中知晓和术后躁动、恶心呕吐的发生情况。结果与T0时比较，T1时ER组血清皮质醇浓度降低（P〈0．05），2组各时点血清醛固酮浓度差异无统计学意义（P〉0．05）。与PR组比较，ER组血管活性药物使用率和注射痛发生率降低，肌颤发生率升高（P〈0．05），苏醒时间、拔除气管导管时间、躁动和恶心呕吐发生率差异无统计学意义（P〉O．05）。结论与TCI丙泊酚复合瑞芬太尼比较，TCI依托咪酯复合瑞芬太尼用于妇科腹腔镜手术时有助于维持血流动力学稳定，对肾上腺皮质功能的抑制作用是一过性的，注射痛发生较少。
Objective To evaluate the anesthetic efficacy of etomidate target-controlled infusion （TCI） in combination with remifentanil in patients undergoing gynecological laparoscopy. Methods Sixty ASA physical sta- tus Ⅰ or Ⅱ patients, aged 25-56 yr, with body mass index 18-27 kg/m2 , undergoing elective gynecological lapa- roscopy, were equally and randomly divided into 2 groups： propofol TCI combined with remifentanil group （group PR） and etomidate TCI combined with remifentanil group （group ER）. Anesthesia was induced with iv injection of midazolam 0.1 mg/kg, fentanyl 4 μg/kg and cisatracurium 0.15 mg/kg in both groups, and with TCI of propoful with the target effect-site concentration （Ce） of 2.5 μg/ml in group PR or with TCI of etomidate （ Ce 0.8 μg/ml） in group ER. The patients were mechanically ventilated after endotracheal intubation. Anesthesia was maintained with TCI of propofol （Ce 2.0-2.5 μg/ml） in group PR or with etomidate （Ce 0.5-0.7μg/ml） in group ER, and with iv infusion of remifentanil 0.1-0.2 μg. kg- 1 .min -1 and intermittent iv boluses of cisatracurium 5 mg. BIS value wasmaintained at 40-60. Before anesthesia （ baseline, T0 ）, at the end of operation （T1）, and at 24 and 48 h after op- eration （T2-3） , venous blood samples were collected for determination of serum cortisol and aldosterone concentra- tions by radioimmunoassay. The emergence time, extubation time and requirement for vasoactive agents during op- eration were recorded. The development of injection pain and muscle twitch during induction of anesthesia, intraop- erative awareness, and post-operative agitation, nausea and vomiting were also recorded. Results Compared with the baseline value at To, the serum eortisol concentration was significantly decreased at T1 in group ER （ P 〈 0.05）, while no significant change was found in serum aldosterone concentrations at each time point in the two groups （ P 〉 0.05） . Compared with group PR, the requirement for vasoactive agents and inc
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第4期462-465,共4页
Chinese Journal of Anesthesiology
