腹腔镜胆囊切除术中靶控输注依托咪酯和丙泊酚的比较

摘要

目的 观察依托咪酯靶控输注的麻醉效果和不良反应,并与丙泊酚比较.方法 择期行腹腔镜胆囊切除术患者40例(ASA Ⅰ～Ⅱ),随机分为依托咪酯组(E组)和丙泊酚组(P组),每组20例.E组靶控输注依托咪酯进行麻醉诱导并维持,P组靶控输注丙泊酚,维持脑电双频指数(BIS)40～60.两组术中持续输注瑞芬太尼0.1～0.5 μg/(kg · min).分别记录麻醉诱导前(基础值)、插管前1 min、插管后(1、3、5 min)、切皮、切皮后15 min、手术结束时的SBP、DBP、HR及苏醒时间、拔管时间、合并用药情况及不良反应.结果 与基础值比较,插管前1 min及插管后3 min、5 min,两组SBP、DBP均显著降低(P<0.05),插管后3 min、5 min及手术切皮时,P组HR显著下降(P<0.05).P组麻黄素、阿托品的使用率高于E组,不良发应发生率低于E组.E组苏醒时间显著长于P组(P<0.05).结论 与丙泊酚相比,靶控输注依托咪酯更有利于血流动力学稳定,但苏醒时间延长,临床应根据需要合理选择.%Objective To evaluate the efficacy and side effect of target controlled infusion(TCI) of etomidate with laparoscopic cholecystectomy(LC). Methods Forty patients( ASA Ⅰ ～ Ⅱ )underwent laparoscopic cholecystectomy were randomized into etomidate group ( Group E, n = 20) and propofol group ( Group P, n = 20 ). Patients in Group E were induced and maintained with TCI etomidate,patients in Group P with TCI propofoi to keep BIS within 40 ～60.Remifentanyl was infused at the rate of 0. 1 ～ 0. 5 μg/( kg· min) for the maintenance of anesthesia in both groups. The SBP, DBP and HR were recorded before anesthesia induction, 1 rain before tracheal intubation, and 1,3,5 rain after tracheal intubation respectively ,they were also recorded at the time of skin incision, 15 rain after skin incision and at the end of LC. Recovery time and side effects were recorded during emergency period. Results Compared with baseline,SBP and DBP decreased significantly before and 3,5 min after tracheal intubation in both groups(P ＜0. 05) ;HR in group P decreased significantly at the time of skin incision and 3,5 rain after tracheal intubation( P ＜0.05). The frequency with ephedrine and atropine in group P was higher, and the side effect rate was lower than that of group E. The recovery time of patients in group E was longer than that of group P during emergency period( P ＜0. 05 ). Conclusion TCI etomidate is easier to maintain stable hemodynamics than TCI propofol, but the recovery time may be prolonged during emergency period. The TCI etomidate for maintenance of anesthesia should be selected reasonably according to the clinical situation.