| 张丽娜,武 婷,潘 旭,范美娇,王 智.靶控输注依托咪脂在老年患者颌面外科手术中的应用效果[J].,2019,19(15):2865-2868 |
| 靶控输注依托咪脂在老年患者颌面外科手术中的应用效果 |
| Clinical Application Effects of Etomidate Target Controlled Infusion for the Elderly Patients Undergoing Dentofacial Surgery |
| 投稿时间：2018-12-21 修订日期：2019-01-17 |
| DOI：10.13241/j.cnki.pmb.2019.15.013 |
| 中文关键词: 依托咪脂 丙泊酚 老年患者 靶控输注 |
| 英文关键词: Etomidate Propofol The aged Target controlled infusion |
| 基金项目:国家自然科学基金面上项目(81571351)；国家自然科学基金青年科学基金项目(81701362)；陕西省重点研发计划——一般项目社会发展领域(2018SF-057) |
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| 中文摘要: |
| 摘要 目的：研究靶控输注依托咪脂在老年患者颌面外科手术中的应用效果。方法：选择60例美国麻醉医师协会(ASA)分级I ~ II级行颌面外科手术的患者，并将其随机分为靶控输注丙泊酚组(P组，n=30)和靶控输注依托咪酯组(E组，n=30)，记录麻醉诱导前、气管插管前、气管插管后5 min、手术开始时、停药时的有创收缩压、有创舒张压、心率，并记录手术时间、拔管时间、麻醉维持时依托咪酯和丙泊酚的靶控输注浓度。结果：P组气管插管前、气管插管后5 min、手术开始时、停药时血压均低于麻醉诱导前，且低于E组各对应时间点，差异均具有统计学意义(P<0.05)，P组气管插管前心率显著低于麻醉诱导前和E组(P<0.05)；E组气管插管前、气管插管后5 min和手术开始时血压均低于麻醉诱导前(P<0.05)，但各时间点心率无显著变化(P>0.05)。P组靶控浓度为(1.95±0.54)μg/mL～(4.48±0.61)μg/mL，E组靶控浓度为(0.20±0.05)μg/mL～(0.51±0.05)μg/mL。两组药物拔管时间、术后恶心呕吐和躁动发生率差异无统计学意义(P>0.05)，但P组低血压发生率显著高于E组(P<0.05)。结论：在颌面外科手术中，靶控输注依托咪脂，能有效减少麻醉诱导和维持中低血压发生，维持血流动力学稳定，对于老年患者而言，是一种比丙泊酚更为安全可靠的静脉麻醉药。 |
| 英文摘要: |
| ABSTRACT Objective: To evaluate clinical effects of etomidate target controlled infusion for the elderly patients undergoing dentofacial surgery. Methods: A total of 60 cases which were treated by dentofacial surgery (American Society of Anesthesiologists I~II) were randomly assigned to the target controlled infusion propofol group (Group P, n=30) and the target controlled infusion etomidate group (Group E, n=30). The invasive systolic pressure, invasive diastolic pressure and heart rate were recorded before induction, before tracheal intubation, at 5 min after tracheal intubation, at the beginning of operation and after drug withdrawal. In addition, the operation time, extubation time and target controlled dose were recorded too. Results: In Group P, the blood pressure before tracheal intubation, at 5 min after tracheal intubation, at the beginning of operation and after drug withdrawal was significantly lower than those before induction (P<0.05), and they were also obviously lower than the relevant time of group E(P<0.05). The heart rate before tracheal intubation of group P was markedly decreased compare with induction time and the same time of group E (P<0.05). In Group E, the blood pressure before tracheal intubation, at 5 min after tracheal intubation and at the beginning of operation was significantly lower than those before induction (P<0.05), but the heart rate was no significant difference each other (P>0.05). During maintenance of anesthesia, the plasma target concentration of propofol was (1.95±0.54)μg/mL～(4.48±0.61)μg/mL, and the plasma target concentration of etomidate was (0.20±0.05)μg/mL～(0.51±0.05)μg/mL. The extubation time, rate of nausea and vomiting, rate of dysphoria showed no significant difference between two groups(P>0.05), but the hypotension of group P was observably higher than that of the group E (P<0.05). Conclusion: Etomidate target controlled infusion effectively reduces the occurrence rate of circulation variation during anesthesia induction and maintenance for the elderly patients undergoing dentofacial surgery. It is a more stable and reliable venous anesthetic for the elderly patients compared with propofol. |
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