依托咪酯全静脉复合麻醉用于腹腔手术效果观察

目曲：比较依托咪酯乳剂复合芬太尼、瑞芬太尼或舒芬太尼全静脉麻醉分别用于腹腔手术的有效性。方法：ASAI或Ⅱ级择期腹腔手术患者60例，随机分为3组：芬太尼组（F组）、瑞芬太尼组（R组）和舒芬太尼组（S组），每组20例。快速诱导后气管插管，麻醉维持各组均静脉持续输注依托咪酯10-15μg·kg-1·h-1，F组间断静脉注射芬太尼1-2μg·kg-1·h-1，R组静脉输注瑞芬太尼O．5-1μg·kg-1·h-1，S组切皮前5min静脉注射舒芬太尼0．5～5μg·kg-1。记录麻醉诱导前（基础值，T0）、气管插管前即刻（T1）、气管插管后3min（T2）、切皮T3）、探查T4）时的平均动脉压（MAP）及心率（HR）；记录手术时间、睁眼时间、拔管时间和PACU停留时间；于拔管后即刻、拔管后30、60min和离开PACU时采用警觉，镇静评分（OAA／S）评价意识状态；记录术中和PACU期间不良反应发生情况。结果：与基础值相比．3组T1时MAP和HR均下降，T3、T4时，F、S组MAP升高，F组HR升高，R、S组HR降低（P〈O．05）；与F组比较，R组T3、T4时MAP、HR降低，S组T3、T4时HR降低；与S组比较，R组T3、T4时MAP降低（P〈O．05）。R组与F组、S组比较，F组与S组比较，睁眼时间、拔管时间和PACU停留时间缩短，拔管后即刻和拔管30minOAA／S评分升高（P〈0．01或P〈0．05）；R组苏醒期躁动发生率高于F组、S组（P〈0．05）。结论：依托咪酯复合芬太尼、瑞芬太尼或舒芬太尼全凭静脉麻醉用于腹腔手术均能取得满意的麻醉效果。依托眯酯复合瑞芬太尼术中血流动力学更趋稳定．术后苏醒迅速，较另两者更佳。

Etomidate total intravenous anesthesia for abdominal surgery

Objective： To compare the efficacy of total intravenous anesthesia （TIVA） of etomidate combined with fentanyl, remifentanil or sufentanil respectively in patients undergoing abdominal proce- dures. Methods： Sixty patients of both sexes, aged 20-60, with body mass index 18-25 kg-1 m2, ASA I or 11, were scheduled for abdominal surgery. They were randomly devided into 3 groups （20 cases in each）： group F, etomidate combined with fentanyl, group R etomidate with remifentanil and group S etomidate with sufentanil. All patients were induced with midazolam 50 μg·kg-1 , fentanyl 4 μg·kg-1 , vecuronium100 μg·kg-1 and etomidate300 μg·kg-1 stepwise, then intubated and ventilated mechanically. Anesthesia was maintained with etomidate 10-15μg·kg-1 min-1 in all patients, combined with fentanyl 1-2 μg·kg-1·h-1 as an intra- venous bolus intermittently in group F, with remifentanil 0.5-1μg·kg-1·h-1 min-1 infused continuously in group R, with sufentanil 0.5-5 μg·kg-1 as a bolus intravenously 5 min prior to skin incision in group S. Following variables were recorded including mean arterial blood pressure （MAP） duction （basline TO, T1）, 3min after intubation （T2）, skin incision（T3）, extubation time, duration of operation, length of stay in PACU ; OAA/S mediately and at 30, 60 rain after extubation and the moment leaving tion and stay in PACU. Results： Compared with baseline, MAP and , heart rate （HR） before and after in- exploration （T4） ; eye-opening time, scores（5=fully awake,1 =asleep） im- PACU ;inverse events during opera- HR at T1 in all groups were lower;MAP were higher at T3, T4 in both groups F and S, HR were higher in group F, HR were lower in group R and S. MAP and HR at T3, T4 in group R were lower than those in group F; Compared with group S, MAP at T3, T4 in group R were lower;HR at T3, T4 in group S were lower than that in group F （P〈0.05 or P〈 0.01）. Eye-opening time, extubation time and length of stay in PACU were shorter, and the OAA/S scores immediately and at 30 min after extubation were higher in group R than those both in group F and S, also in group F than that in group S（P〈0.01 or P〈0.05 ）.The incidence of restlessness were higher in group R than that in group F and S （P〈0.05）. Conclusion： Total intravenous anesthesia of etomidate combined with fen- tanyl, remifentanil or sufentanil can achieve satisfactory anesthetic efficacy for abdominal procedures. Pa- tients＇ hemodynamics are more stable during operation and recovery from anesthesia is more quickly when etomidate combined with remifentanil than with orthers.