依托咪酯静脉不同速度输注对胸科手术患者麻醉诱导期肌阵挛的影响

摘要

[目的]:研究依托咪酯麻醉诱导期静脉不同速度输注,对胸科手术患者肌阵挛的影响.[方法]:选择全身麻醉下行胸科手术男性患者90例,随机分为3组,在麻醉诱导期首先以不同的速度静注0.3 mg/kg的依托咪酯.V200组30例,输注速度为200 μg/s;V400组30例,输注速度为400μg／s；V800组30例,输注速度为800 μg／s.3组患者均在入睡后静注肌松剂和芬太尼镇痛.记录各组在开始静注依托咪酯即刻(T0)、停止注药时(T1)及停止注药后2 min(T2)的平均动脉压(MAP)、心率(HR)和经皮脉搏氧饱和度(SpO2)等参数、输注时间以及T0至T2期间是否发生肌阵挛及其程度.[结果]:3组肌阵挛发生率分别为3.3％、33.3％及73.3％,各组间比较差异均有统计学意义(P＜0.05).3组患者间肌阵挛程度分级比较,V200组,低于V400组低于V800组,差异均有统计学意义(P＜0.05).且V200组和V400组程度以1级为主,而V800组程度以3级为主.HR和SpO2值在组间和组内各时点比较差异均无统计学意义.MAP值分别在T1、T2时点组间比较V800组均低于V200组,差异均有统计学意义(P＜0.05),V400组和V800组MAP值分别在组内比较T1、T2时点均明显低于T0点,差异均有统计学意义(P＜0.05).[结论]:减慢依托咪酯的输注速度,可以明显降低肌阵挛的发生率及肌阵挛的程度,合理的输注速度还可以避免依托咪酯对平均动脉压的降低.%Objective;To investigate the effect of the different etomidate infusion speed on etomidate-induced myoclonus during anesthesia induction for patients undergoing lung surgery. Methods; A total of 90 male patients scheduled for thoracic surgery under genaral anesthesia were divided randomly into 3 groups with 30 cases each according to etomidate infusion speed in anesthesia induction. During anesthesia induction, etomidate 250 μg/kg was infused firstly and then solely with etomidate infusion by the speed of 200 μg/s( group V200 ),400μg/s( group V400) of 800 μgM group V800). After the intravenous infusion of etomidate, the scales and incidences of myoclonus were observed and the value of MAP, HR and SpO2 was recorded at the following time points: the beginning (T0) and the end (T1) of infusion of etomidate and 2 min (T2) after the infusion finished. Results; The positive incidences of myoclonus were 3.3% in group V200, 33.3% in group V400, 73. 3% in group V800 , respectively. Compared with group V400 or V800, groups V200 had lower positive incidences and scales significantly (P < 0. 05). Conclusion: Reducing the infusion speed of etomidate may reduce the incidences and the scales of etomidate-induced myoclonus during anesthesia induction.