發(fā)布時(shí)間：2018-11-25 19:34

【摘要】：目的：依托咪酯和異丙酚是常用的靜脈麻醉藥。二者都屬于非巴比妥類鎮(zhèn)靜藥。異丙酚又名丙泊酚（propofol）,它是一種靜脈麻醉藥，具有快效短效蘇醒迅速而完全及持續(xù)輸注后無蓄積的特點(diǎn)�，F(xiàn)如今異丙酚普遍用于麻醉誘導(dǎo)和麻醉維持，藥物常用于麻醉中，手術(shù)后和ICU病房的鎮(zhèn)靜。依托咪酯（etomidate）在1964年被合成，在1972年被推薦用于臨床。這種藥為咪唑類衍生物，是催眠性鎮(zhèn)靜麻醉藥，麻醉誘導(dǎo)和蘇醒較快，相對(duì)安全，故臨床應(yīng)用較多。隨著全麻患者的日益增多，氣管插管可以為手術(shù)期間提供一個(gè)安全氣道，另外喉鏡檢查也日益增多。氣管插管和喉鏡檢查最重要的副作用包括心血管反應(yīng)。先前的研究認(rèn)為依托咪酯可以用于血流動(dòng)力學(xué)儲(chǔ)備有限的的患者，而異丙酚會(huì)導(dǎo)致更多的血流動(dòng)力學(xué)不穩(wěn)定。本研究探討在燒傷患者手術(shù)時(shí)用依托咪酯和異丙酚麻醉誘導(dǎo)，對(duì)患者的心血管反應(yīng)進(jìn)行比較。 材料和方法：我們選擇了包括年齡在19-62歲之間的50例燒傷病人，50名燒傷患者的性別構(gòu)成是33名男性，17名女性�；颊唧w重在51kg至86kg之間�；颊叻裾J(rèn)高血壓、腦梗、心肝腎功能不全、糖尿病、腎上腺疾病史，沒有長期應(yīng)用大劑量糖皮質(zhì)激素治療。他們是2013年不幸被燒傷的患者，燒傷深度是II度-III度，燒傷面積為35%-70%。這些患者頭面部有不同程度的燒傷，但均沒有精神障礙和嚴(yán)重的呼吸道損傷，這50名患者沒有麻醉藥過敏史�；颊逜SAI級(jí)（美國麻醉醫(yī)師協(xié)會(huì)），手術(shù)前對(duì)病人病史和一般情況進(jìn)行評(píng)估，對(duì)一般資料例如患者性別、年齡、體重及體重指數(shù)進(jìn)行了解，常規(guī)檢查患者的血常規(guī)、尿常規(guī)、肝腎功能、電解質(zhì)、常規(guī)心電圖、胸片。兩組患者參與實(shí)驗(yàn)，在手術(shù)之前按照常規(guī)進(jìn)行禁食8小時(shí)，禁飲4小時(shí)，阿托品0.5mg術(shù)前30分鐘肌注，苯巴比妥鈉100mg術(shù)前30分鐘肌注。病人被隨機(jī)分成兩組，A組用依托咪酯（0.3mg/kg），B組用異丙酚（2-2.5mg/kg），觀察他們?cè)诤礴R檢查前和麻醉誘導(dǎo)后的1分鐘，3分鐘，5分鐘，10分鐘的心血管反應(yīng)，觀察的心血管反應(yīng)指標(biāo)包括：收縮壓（SBP），舒張壓（DBP），平均動(dòng)脈壓（MAP），心率（HR）和血氧飽和度（SPO2）。 結(jié)果：兩組在性別，年齡，，體重指數(shù)和喉鏡檢查的困難程度上沒有明顯的統(tǒng)計(jì)學(xué)差異（P0.05）。但是B組的收縮壓明顯提高(P=0.019)，此外B組的舒張壓也明顯提高(P=0.001)，平均動(dòng)脈壓B組也變高(P=0.008)。而低血壓的發(fā)生率在B組達(dá)到26.1%，在A組是8%（P=0.09）。A組和B組在心率方面（P=0.47），血氧飽和度方面（P=0.21），心動(dòng)過速（P=0.6）和心動(dòng)過緩方面（P=0.66）沒有明顯的差異。 結(jié)論：病人接受依托咪酯有更穩(wěn)定的血流動(dòng)力學(xué)狀態(tài)，收縮壓（SBP），舒張壓（DBP），平均動(dòng)脈壓（MAP）平穩(wěn)，可以減輕患者的心血管反應(yīng)，因此如果沒有禁忌癥，可以優(yōu)先于異丙酚用于喉鏡檢查，氣管插管全身麻醉。依托咪酯用于喉鏡檢查和麻醉誘導(dǎo)氣管插管相對(duì)安全，便捷，對(duì)于燒傷患者和心血管患者是理想用藥。
[Abstract]:Objective: etomidate and propofol are common intravenous anesthetics. Both belong to non-barbiturates. Propofol, also known as propofol (propofol), (propofol), is an intravenous anesthetic with the characteristics of quick and short effect recovery, complete and no accumulation after continuous infusion. Propofol is now widely used in anesthesia induction and maintenance, and in anesthesia, after surgery, and in ICU ward sedation. Etomidate (etomidate) was synthesized in 1964 and recommended for clinical use in 1972. This drug is a derivative of imidazole, hypnotic sedation anesthetic, anesthesia induction and recovery faster, relatively safe, so clinical application is more. With the increasing number of patients with general anesthesia, tracheal intubation can provide a safe airway during surgery, and laryngoscopy is also increasing. The most important side effects of tracheal intubation and laryngoscopy include cardiovascular reactions. Previous studies have suggested that etomidate can be used in patients with limited hemodynamic reserves, while propofol leads to more hemodynamic instability. The aim of this study was to investigate the cardiovascular response of burn patients induced by etomidate and propofol. Materials and methods: we selected 50 burn patients aged between 19 and 62. The gender composition of 50 burn patients was 33 males and 17 females. The patient's weight ranged from 51kg to 86kg. Patients denied hypertension, cerebral infarction, heart, liver and kidney dysfunction, diabetes, history of adrenal disease, and no long-term use of high-dose glucocorticoids. They were patients with unfortunate burns in 2013. The burn depth was II-III, and the burn area was 35-70. The patients had varying degrees of burns on the head and face, but no mental disorders and severe respiratory injuries. The 50 patients had no history of anaesthetic allergy. ASAI (American Association of Anesthesiologists), who assess the patient's history and general situation before surgery, understand general data such as gender, age, body mass and body mass index, routinely examine the patient's blood routine and urine routine, Liver and kidney function, electrolyte, routine electrocardiogram, chest radiography. The two groups of patients participated in the experiment, fasting 8 hours before operation, forbidding 4 hours, atropine 0.5mg 30 minutes before intramuscular injection, phenobarbital sodium 100mg 30 minutes before intramuscular injection. Patients were randomly divided into two groups: group A received etomidate (0.3mg/kg), B group) with propofol (2-2.5mg/kg), and they were observed before laryngoscopy and 1, 3, 5 minutes after anesthesia induction. After 10 minutes of cardiovascular response, systolic pressure, (SBP), diastolic blood pressure, (DBP), mean arterial pressure, (MAP), (HR), and blood oxygen saturation (SPO2) were observed. Results: there was no significant difference in sex, age, BMI and laryngoscopy between the two groups (P0.05). But the systolic blood pressure in group B was significantly increased (P0. 019), the diastolic blood pressure in group B was also significantly increased (P0. 001), and the mean arterial pressure in group B was higher (P0. 008). The incidence of hypotension was 26.1% in group B, 8% in group A (P0. 09). A and group B) in heart rate (P0. 47), and in saturation of blood oxygen (P0. 21). There was no significant difference in tachycardia (P 0. 6) and bradycardia (P 0. 66). Conclusion: patients receiving etomidate have a more stable hemodynamic state, systolic (SBP), diastolic blood pressure (DBP),) mean arterial pressure (MAP) is stable, which can alleviate the cardiovascular response of patients, so if there is no contraindication, It can take precedence over propofol for laryngoscopy, tracheal intubation and general anesthesia. Etomidate is relatively safe and convenient for laryngoscopy and anesthesia induction tracheal intubation. It is an ideal drug for burn patients and cardiovascular patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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