靶控输注依托咪酯用于全身麻醉维持的可行性研究

目的 探讨靶控输注(TCI)依托咪酯用于全身麻醉维持的可行性.方法 择期全麻手术患者40例,随机分为两组.E组麻醉诱导时TCI依托咪酯和雷米芬太尼;P组TCI丙泊酚和雷米芬太尼.E组术中TCI依托咪酯1～2μg/ml和雷米芬太尼6 ng/ml维持BIS值40～60;P组术中TCI丙泊酚2～4 μg/ml和雷米芬太尼6 ng/ml维持BIS值40～60.检测围术期血糖、血浆皮质醇、醛同酮、促肾上腺皮质激素(ACTH)浓度.记录停药后患者苏醒时间,术后随访术中知晓.结果 两组术中血流动力学均维持稳定.E组术毕皮质醇浓度与术前相比明显降低(P<0.05),术后24 h基本恢复至术前水平,术后48 h较术前明显升高(P<0.05);术毕ACTH浓度与术前相比明显升高(P<0.05),术后24 h基本恢复至术前水平.而P组围术期血浆皮质醇和ACTH浓度均无明显改变.E组苏醒时间长于P组(P<0.05).结论 依托咪酯抑制肾上腺皮质功能,但在24 h内肾上腺皮质即恢复对促肾上腺皮质激素的反应.TCI依托咪酯复合雷米芬太尼可安全用于无肾上腺皮质功能低下患者的全凭静脉麻醉.

Feasibility of TCI etomidate for total intravenous anesthesia

Objective To study the feasibility of TCI etomidate for total intravenous anesthesia (TIVA). Methods Forty patients scheduled for abdominal operation were divided into two groups with 20 cases each. Anesthesia in group E was induced and maintained with TCI etomidate 1-2 μg/ml and remifentanil 6 ng/ml,which in group P with TCI propofol 2-4 μg/ml and remifentanil 6 ng/ml to keep BIS 40-60. The perioperative changes of plasma glucose, cortisol, aldosterone and ACTH were Observed. Recovery from anethesia was recorded as well Results Both groups had the stabilized hemodynamics and glucose concentration. The plasma cortisol and ACTH concentrations in group E were decreased at the end of operation(P<0.05), but returned to preoperative level on the next day, which were not significantly changed perioperatively in group P. The time of eye opening was longer in group E than that in group P. Conclusion Etomidate has an inhibition on the function of the adrenal cortex temporally and can be used safely togather with remifentanil for TIVA in patients without hypoadrenocorticism.