依托咪酯全凭静脉麻醉在食道癌根治术中的临床观察

目的：观察依托咪酯全凭静脉麻醉（total intervenous anesthesia,TIVA）在食道癌根治术围术期患者血浆皮质醇含量及血流动力学的变化。方法将ASAⅡ～Ⅲ级择期拟行食道癌根治术患者60例随机分为依托咪酯组（E组,n=30）和丙泊酚组（P组,n=30）。E组麻醉诱导依托咪酯为0.3mg·kg^-1;P组麻醉诱导时丙泊酚为1.5mg·kg^-1,两组其余诱导药物一致。分别于麻醉诱导前5min（T0）、手术结束时（T1）、术后24h（T2）、48h（T3）和72h（T4）抽取静脉血测定患者血浆皮质醇浓度;记录麻醉前、诱导后、插管时刻、插管后10min、切皮时、手术1h及术毕血流动力学的变化;记录两组患者睁眼时间,拔管时间和围术期不良反应。结果：P组各观察时点血浆皮质醇浓度均有不同程度的升高;E组的T1血浆皮质醇浓度下降明显,与麻醉前和P组比较有统计学意义（P〈0.05）;两组患者术后48h血浆皮质醇浓度明显升高,与麻醉前比较有统计学意义（P〈0.05）,术后72h均可恢复至术前水平。两组患者术中血流动学均有不同程度的变化,以P组波动较为明显,E组则较平稳;E组的拔管时间比P组长（P〈0.05）,而睁眼时间无统计学意义（P〉0.05）;E组患者麻醉诱导肌颤发生率明显高于P组（P〈0.05）。结论：依托咪酯对血流动学影响较轻,围术期无严重不良反应,可长时间、大剂量安全用于无肾上腺皮质功能减退的重大创伤患者的全凭静脉麻醉。

Total Intravenous Anesthesia with Etomidate in Patients Undergoing Radical Resection of Esophageal Carcinoma

OBJECTIVE：To observe the effect of etomidate used by total intravenous anesthesia（TIVA） on plasma hemodynamics and the content of corticosteroid perioperatively in esophageal carcinoma patients undergoing radical resection of carcinoma.METHODS：Sixty patients undergoing selective radical resection of esophageal carcinoma（ASAⅡ-Ⅲ） were randomly assigned to receive etomidate（0.3 mg·kg^ -1）（group E,n =30） or propofol（1.5 mg·kg ^-1）（group P,n =30） for anesthesia induction.The other induction drugs received by the two groups were the same.The plasma concentrations of corticosteroids were determined at 5 minutes prior to anesthesia（T0）,after the completion of operation（T1）,and at 24 hours（T2）,48 hours（T3）,and 72 hours（T4） postoperatively,respectively.The hemodynamic change was recorded prior to anesthesia,after anesthesia induction,at the time of intubation,10 min after intubation,at the time of incision cutting,at 1 h of operation,and after the completion of operation,respectively.The time to regain eyes open,the extubation time and the perioperative side effects were recorded.RESULTS：The plasma concentrations of corticosteroid in group P all elevated in different levels at all time points,whereas the plasma concentration of corticosteroid at T1 in group E declined significantly,showing significant differences as compared with before anesthesia or compared with group P（P〈0.05）.The plasma concentrations of corticosteroid in both groups at T3 significantly elevated as compared with before anesthesia（P〈0.05）,at 72 h,which returned to the level before anesthesia.The hemodynamics in both group showed change to a different degree,much as in group P,and that in group E was stable.The extubation time in group E was longer than in group P（P〈0.05）,but the difference in the time to regain eyes open between the two group was not statistically significant（P〉0.05）.The incidence of amyostasia in group E was significantly higher than in group P（P〈0.05）.CONCLUSION：With mild side effects,Etomidate had a little impact on hemodynamics perioperatively in esophageal carcinoma patients undergoing radical resection of carcinoma.It can be safely used for a long time in large dose by TIVA in patients undergoing major trauma in the absence of adrenocortical hypofunction.