依托咪酯对高龄和休克病人全麻诱导血液动力学的影响

目的 观察依托咪酯乳剂全麻诱导对高龄和休克病人血液动力学的影响。方法 选择100例ASAⅡ~Ⅲ级老年或出血性休克的手术病人,用芬太尼4μg/kg、维库溴铵0.1mg/kg、依托咪酯0.2~0.3mg/kg进行麻醉诱导,监测平均动脉压(MAP)、心率(HR)、每搏量(SV)、每膊指数(SI)、心排血量(CO)、心脏指数(CI)、心脏加速度(ACI)、左心功(LCW)及左心功指数(LCWI)。分别于诱导前、静注依托咪酯1、2、3min以及气管内插管后3min,记录上述指标。结果 与诱导前比较,静注依托咪酯后1~3minMAP、HR、SV、SI、CO、CI、ACI、LCW、LCWI均有不同程度降低(P<0.05)。气管插管后3min,MAP、HR、CO、CI、ACI较诱导前明显升高(P<0.05),其余指标均恢复至基础值水平。整个诱导过程中心功能的各指标的最大改变均不超过20%。结论 依托咪酯麻醉诱导对高龄和休克病人血液动力学的影响轻微。对于血液动力学不稳定病人,依托咪酯是麻醉诱导的较佳选择。

Effect of etomidate on hemodynamics in elderly and shock patients during general anesthesia induction

Objective To investigate the effect of etomidate on the hemodynamics in elderly and shock patients during general anesthesia induction. Methods Totally 100 elderly patients or patients with hemorrhagic shock (ASAⅡ -Ⅲ) undergoing surgery were studied. Anesthesia was induced with 4 μg/kg of fentanyl, 0.1 mg/kg of vecuronium and 0.2-0.3 mg/kg of etomidate, and the mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV), stroke index (SI), cardiac output (CO), cardiac index (CI), cardiac acceleration index (ACI), left cardiac work (LCW), and left cardiac work index (LCWI) were recorded using thoracic electrical bioimpedance (TEB) hemodynamic monitoring system before induction and at 1, 2 and 3 min after etomidate injection as well as at 3 min after intubation. Results After etomidate injection, MAP, HR, SV, SI, CO, CI, ACI, LCW and LCWI were decreased significantly as compared with those before induction (P<0.05). MAP, HR, CO, CI and ACI at 3 min after intubation were higher than those before induction (P<0.05), and the other indices resumed the baseline level. The amplitudes of such changes in the recorded indices was below 20% of the baseline level in the course of anesthesia induction. Conclusion Cardiovascular hemodynamics may vary slightly during the course of induction with etomidate, which is an ideal drug for anesthesia induction for elderly or shock patients with unstable hemodynamics.