依托咪酯和咪达唑仑在冠脉搭桥手术麻醉诱导期对脑电双频指数及血流动力学的影响

目的比较依托咪酯和咪达唑仑在冠状动脉旁路移植手术麻醉诱导期对脑电双频指数（BIS）及血流动力学的影响。方法择期行冠状动脉旁路移植手术患者46例,随机分成依托咪酯组（Ⅰ组,n=23）和咪达唑仑组（Ⅱ组,n=23）。在麻醉诱导期,Ⅰ组给予依托咪酯0.3 mg/kg,Ⅱ组给予咪达唑仑0.1 mg/kg,两组同时给予利多卡因1 mg/kg、舒芬太尼1μg/kg和维库溴铵0.15 mg/kg后行气管插管。观察两组患者脑电双频指数及血流动力学的变化。结果与麻醉诱导前相比,诱导后两组心率（HR）、收缩压（SBP）、平均动脉压（MBP）及BIS值均明显下降（P〈0.05）。诱导后1 min,Ⅱ组BIS值明显高于Ⅰ组（P〈0.05）。诱导后3 min,Ⅱ组HR、SBP、MBP较Ⅰ组明显降低（P〈0.05）;诱导后5 min,Ⅱ组HR较Ⅰ组明显降低（P〈0.05）。结论与咪达唑仑相比,依托咪酯起效迅速,对血流动力学影响轻微,更适用于冠脉搭桥手术的麻醉诱导。

Comparison of Etomidate Versus Midazolam on Hemodynamics and Bispectral Index in Cononary Artery Bypass Patients during General Anesthesia Induction

OBJECTIVE To compare the effect of etomidate and midazolam on hemodynamics and bispectral index（BIS） in cononary artery bypass grafting（CABG） patients during general anesthesia induction.METHODS Forty-six patients undergoing CABG surgery were randomized into two groups.Patients in groupⅠwere induced with etomidate（0.3 mg/kg）,patients in group Ⅱ were induced with midazolam（0.1 mg/kg）.Patients in both groups were injectived with lidocaine（1 mg/kg）、sulfentanyl（1 μg/kg） and vecuronium（0.15 mg/kg） before the intubation.The hemodynamics and BIS were recorded.RESULTS HB,SBP,MBP and BIS in both groups decreased significantly after the induction（P〈0.05）.One minutes after induction,BIS decreased significantly in group Ⅱ than that in groupⅠ（P〈0.05）.Three minutes after induction HR,SBP and MBP increased significantly in group Ⅱ than that in groupⅠ（P〈0.05）.Five minutes after induction HR decreased significantly in group Ⅱ than that in groupⅠ（P〈0.05）.CONCLUSION Etomidate is more stable and safer than midazolam on the effect of hemodynamics during induction of anesthesia in patients undergoing CABG surgery.