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依托咪酯乳剂复合瑞芬太尼全凭静脉麻醉的临床观察

张红涛1,杨勇2,于泳浩1,王国林3   

  1. 1. 天津医科大学总医院麻醉科
    2. 总医院麻醉科
    3. 天津医大总医院
  • 收稿日期:2010-09-17 修回日期:2010-12-20 出版日期:2011-09-15 发布日期:2011-09-15
  • 通讯作者: 杨勇

The clinical observation of etomidate emulsion combined with remifentanil in total intravenous anesthesia

  • Received:2010-09-17 Revised:2010-12-20 Published:2011-09-15 Online:2011-09-15

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摘要： 目的 探讨全凭静脉麻醉中应用依托咪酯乳剂复合瑞芬太尼维持麻醉的麻醉效能。方法 选择择期全麻下行中下腹部手术患者50例，ASA分级Ⅰ～Ⅱ级，手术时间均在3小时以内，随机分为两组（n=25），两组患者麻醉诱导一致，依托咪酯组（E组）恒速泵注依托咪酯，丙泊酚组(P组)恒速泵注丙泊酚，均复合瑞芬太尼维持麻醉。术中以脑电双频指数（BIS值）维持在40～60为指标，调节依托咪酯和丙泊酚的泵注速度。记录术中两组患者的血流动力学变化；记录依托咪酯和丙泊酚的输注速度并计算单位时间用药量；记录两组患者意识恢复的时间；记录两组患者术后恶心、呕吐及躁动的发生情况。结果 两组患者术中血流动力学 均维持稳定；BIS值维持在40～60之间，依托咪酯的泵注速度为(7.74±1.11)μg?kg-1?min-1，用药数量（1.61±0.39）支/小时；丙泊酚的泵入速度为(5.62±0.83) mg?kg-1?h-1，用药数量（1.92±0.47）支/小时；两组患者意识恢复时间相近，苏醒过程中均未发生恶心、呕吐及躁动。结论 相对于丙泊酚，复合瑞芬太尼用于3小时内手术的全凭静脉麻醉，依托咪酯乳剂具有较高的麻醉效能和性价比。

关键词: 依托咪酯乳剂, 丙泊酚, 全凭静脉麻醉, 瑞芬太尼

Abstract: Objective To detect the anesthetic efficiency of etomidate emulsion，which was used in total intravenous anesthesia (TIVA) combined with remifentanil. Methods 50 patients in ASA Ⅰ～Ⅱ underwent elective general anesthesia for middle and lower abdominal surgery were selected, the operations time were all within 3 hours, these patients were randomly divided into two groups: group E(etomidate) and group P(propofol), they were induced with the same method, we transfused etomidate and remifentanil in group E and propofol and remifentanil in group P continuously to maintain anesthesia, maintain the bispectral index（BIS）between 40 and 60,which guided the transfused speed of etomidate and propofol.; The hemodynamic changes of the patients in the two groups were recorded; The transfused speed and the dosage inside unit time of etomidate and propofol were recorded and calculated; The consciousness recover time of patients were recorded. The happenings of postoperative nausea and vomiting, dysphoria were recorded. Results The hemodynamic changes were stable in the two groups; Maintained the BIS between 40 and 60,the intravenous speed of etomidate was( 7.74±1.11) ug.kg-1.min-1,the dosage was（1.61±0.39）bottle per hour; The intravenous speed of propofol was(5.62±0.83) ug.kg-1.min-1,the dosage was（1.92±0.47）bottle per hour; The consciousness recover time of patients in the two groups were close, there was no happening of postoperative nausea and vomiting、dysphoria during anesthesia resuscitation; Conclusion Combined with remifentanil in total intravenous anesthesia to maintain anesthesia within 3 hours, etomidate emulsion had higher anesthetic efficiency and cost performance compared with propofol.

Key words: Etomidate emulsion, propofol, total intravenous anesthesia, Remifentanil