依托咪酯复合丙泊酚在腹腔镜胆囊切除术中的应用

摘要

目的 观察依托咪酯复合丙泊酚诱导用于腹腔镜胆囊切除术的临床效果.方法 选择2015年3月至2016年4月在我院行腹腔镜胆囊切除术的患者80例,男44例,女36例,ASA Ⅰ或Ⅱ级.按随机数表法均分为四组,每组20例.A组:静注丙泊酚2 mg/kg;B组:静注依托咪酯0.3 mg/kg;C组静注依托咪酯0.15mg/kg、丙泊酚1 mg/kg;D组静注依托咪酯0.1 mg/kg、丙泊酚1.5mg/kg.麻醉诱导完成后行快速气管内插管.观察和记录麻醉诱导给药前(T0)、插管前1 min(T1)、插管时(T2)、插管后1min(T3)、插管后5 min(T4)、插管后15 min(T5)四组患者的HR、BP;采集四组在T0、麻醉诱导后30 min(Tb)、麻醉诱导后2 h(Tc)、麻醉诱导后24 h(Td)的静脉血,离心后取血清,采用放射性免疫法测血清中的皮质醇(Cor)、醛固酮(ALD)以及促肾上腺皮质激素(ACTH);记录并比较四组患者诱导时注射痛、肌阵挛及术后恶心呕吐等不良反应的发生率.结果 与T0时比较,T1、T4、T5时A组,T1、T5时D组HR明显减慢(P＜0.05);T1、T4、T5时A组,T1、T5时C组,T1、T5时D组SBP明显降低,T2时B组SBP明显升高(P＜0.05).与T0时比较,Tb、Tc时B、C组Cor、ALD明显降低,Tb、Tc时B组,Tc时C组ACTH明显升高(P＜0.05);Tb、Tc时B、C组Cor、ALD明显低于A组,Td时B、C组ALD明显高于A组(P＜0.05);Tb时C组ACTH明显高于A组(P＜0.05);Tb、Tc时C、D组Cor、ALD明显高于B组(P＜0.05);Tb、Tc时D组Cor、ALD明显高于C组(P＜0.05).结论 依托咪酯复合丙泊酚诱导可减轻单纯丙泊酚或单纯依托咪酯诱导时的应激反应,是一种值得推广的麻醉诱导方式.%Objective To observe the clinical effect of etomidate combined with propofol on laparoscopic cholecystectomy.Methods Eight patients undergoing laparoscopic cholecystectomy cho sen from March 2015 to April 2016 in our hospital,falling into ASA Ⅰ or Ⅱ grades,randomly divided into four groups,20 in each.Group A was administered of propofol (2 mg/kg);group B etomidate (0.3 mg/kg);group C etomidate (0.15 mg/kg) combined with propofol (1 mg/kg);group D etomidate (0.1 mg/kg) combined with propofol (1.5 mg/kg).Systolic blood pressure,diastolic blood pressure and heart rate of the four group were compared at the following six time points:before anesthesia induction(T0),1 min before intubation (T1),the intubation moment (T2),1 min after intubation (T3),5 min after intubation (T4),15 min after intubation (T5).The serum of four groups were collected at the time before anesthesia induction (T0),30 min after anesthesia induction (Tb),2 h after induction of anesthesia (Tc) and 24 h after anesthesia induction(Td).Aldosterone,cortisol and adrenocorticotropic hormone in serum were tested by radioimmunoassay.The incidence of adverse reactions such as injection pain and myoclonus during induction,and postoperative nausea and vomiting of the four groups were recorded and compared.Results Compared with T0,HR,SBP at T1,T4 and T5 were significantly decreased in group A (P＜0.05).SBP at T2 were significantly increased in group B (P＜0.05),and SBP at T1 and T5 were significantly decreased in group C (P＜0.05).There was no significant difference of HR at T1,T2,T3,T4 and T5 in group B and C.Compared with T0,HR,SBP at T1,and T5 were significantly decreased in group D (P＜0.05).There was no significant difference in hemodynamics among the four groups.Compared with T0,the levels of Cor and ALD at Tb and Tc were decreased in group B and C (P＜0.05).And the level of ACTH of B and C in Tc were significantly increased (P＜0.05).Compared with group A,the levels of Cor and ALD of group B and C were significantly decreased at Tb and Tc (P＜0.05).Compared with group B,the levels of Cor and ALD of group C and D showed less decrease at Tb and Tc (P＜0.05).And compared with group C,the levels of Cor and ALD of group D showed less decrease at Tb and Tc (P＜0.05).Conclusion Etomidate combined with propofol induced can reduce the side effects induced by propofol or etomidate alone,which is an ideal way of anesthesia induction.