异丙酚与依托咪酯诱导对血浆皮质醇浓度的影响

目的　观察异丙酚与依托咪酯诱导对肾上腺皮质功能的影响。方法　在 2 0例择期手术麻醉的患者中分别对 2 m g/kg异丙酚与 0 .3 m g/kg依托咪酯诱导时血浆皮质醇浓度的变化进行观察。结果　异丙酚组给药后 2 h血浆皮质醇浓度由 (30 8.7± 2 7.4) nm ol/L降至 (2 6 7.7± 31.2 ) nm ol/L ,5 h后升高至 (4 0 0 .2± 2 6 .9) nm ol/L ,2 4h后恢复至给药前水平为 (30 6 .4± 35 .4) nm ol/L ;依托咪酯组给药后 2 h血浆皮质醇浓度由 (30 9.1± 36 .6 ) nm ol/L降至 (115 .9± 2 9.7) nm ol/L ,5 h时维持在 (171.1± 34.7) nm ol/L ,2 4h后恢复至给药前水平为 (311.8± 46 .2 ) nm ol/L。结论　异丙酚诱导对肾上腺皮质功能影响小 ,依托咪酯诱导则造成短暂的肾上腺皮质功能抑制。

Effect of propofol and etomidate for anesthesia induction on plasma total cortisol concentration

OBJECTIVE: To investigate the effect of propofol and etomidate for anesthesia induction on adrenocortical function. METHODS: The plasma total cortisol concentration was determined in 20 patients who were treated with propofol or etomidate. RESULTS: After propofol induction, the plasma total cortisol level decreased from (308.7 +/- 27.4) nmol/L to (267.7 +/- 31.2) nmol/L at post-medication 2 hours, increased to (400.2 +/- 26.9) nmol/L at postmedication 5 hours and restored to premedication level at postmedication 24 hours (306.4 +/- 35.4) nmol/L]. After etomidate induction, the plasma total cortisol level decreased from (309.1 +/- 36.6) nmol/L to (115.9 +/- 29.7) nmol/L at postmedication 2 hours, maintained (171.1 +/- 34.7) nmol/L at postmedication 5 hours and restored to premedication level at postmedication 24 hours (311.8 +/- 46.2) nmol/L]. CONCLUSIONS: Propofol induction has little effect on adrenocortical function whereas etomidate induction inhibits adrenocortical function.