依托咪酯在老年心脏病患者非心脏手术中的应用

摘要

Objective To investigate the feasibility of etomidate administrated in non-cardiac surgery in elderly patients with heart disease.Methods The elderly patients with heart disease undergone laparoscopic cholecystectomy under general anesthesia (n=60) were chosen from Nov. 2014 to Aug. 2015, and randomly divided, according to ASA grading, into etomidate group (E group) and propofol group (P group, eachn=30). During anesthesia induction, E group was given etomidate (0.2 mg/kg~0.3 mg/kg) and P group was given propofol (1 mg/kg~2 mg/kg). The changes of monitored invasive artery pressure (MAP), heat rate (HR), cardiac output (CO), cardic index (CI), stroke volume (SV) and stroke variation index (SVI) were recorded before anesthesia induction (T1) and at moment of tracheal intubation (T2), 3 min after anesthesia induction (T3), procedure starting time (T4), time of pneumoperitoneum establishment (T5), time of gallbladder excision (T6) and finishing time of procedure (T7). Results The general condition, dosage of anesthetics, and revive time had no statistical difference between two groups (P>0.05). Compared with E group, MAP and HR decreased significantly at time points of T2 and T3 (P<0.05), CO, CI and SV decreased significantly at time points from T2 to T6 (P<0.05), and SVI increased significantly at time points from T2 to T6 (P<0.05) in P group.Conclusion The general anesthesia with etomidate can well maintain stable hemodynamics and reduce anesthesia risk in non-cardiac surgery in elderly patients with heart disease.%目的：探讨依托咪酯用于老年心脏病患者非心脏手术的可行性。方法选择2014年11月~2015年8月全麻下行腹腔镜胆囊切除术的老年心脏病患者60例，美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级，随机分为两组，依托咪酯组（E组，n=30））和丙泊酚组（P组，n=30）。麻醉诱导时，E组给予依托咪酯0.2~0.3 mg/kg，P组给予丙泊酚1~2 mg/kg。术中维持麻醉/脑电意识监测系统（Narcotrend）监测在D1-D2级，麻醉深度指数（NT）指数于40~60之间，据此调整依托咪酯或丙泊酚泵注速度。并于麻醉诱导前（T1）、气管插管即刻（T2）、气管插管后3min（T3）、手术开始时（T4）、气腹建立时（T5）、胆囊切除时（T6）、手术结束时（T7）记录有创动脉血压（MAP)、心率（HR)、心输出量（CO）、心排指数（CI）、每搏量（SV)、每搏变异指数（SVV）。结果两组患者的一般情况、麻醉用药及苏醒时间均无统计学差异（P＞0.05）；与E组相比，P组T2、T3时间点MAP、HR明显下降（P＜0.05），T2~T6时间点心输出量CO、心排指数CI、每搏量SV明显下降（P＜0.05），而P组T2~T6时间点每搏变异指数SVV明显升高（P＜0.05）。结论依托咪酯静脉麻醉用于老年心脏病患者非心脏手术，能更好的维持血流动力学平稳，降低麻醉风险。