依托咪酯和丙泊酚诱导对心脏瓣膜置换术病人血流动力学的影响

目的:观察丙泊酚或依托咪酯全麻诱导对心脏瓣膜置换病人血流动力学的影响。方法:选择心功能Ⅲ级,择期行心脏瓣膜置换病人50例,随机分为丙泊酚组(P组)及依托咪酯组(E组),每组25例,分别静脉注射丙泊酚2.5m g/kg和依托咪酯乳剂0.3m g/kg,再给予维库溴铵0.15m g/kg和芬太尼4μg/kg,3m in后行气管内插管。记录诱导前、诱导后1m in、3m in以及插管后1m in、3m in和5m in时的心率(HR)、动脉收缩压(SBP)、动脉舒张压(SDP)、平均动脉压(MAP)、中心静脉压(CVP)和脉搏血氧饱和度(SpO2)。结果:用药后两组病人血压和心率均呈不同程度下降,诱导后3m in,丙泊酚组SBP、DBP比诱导前显著降低(P<0.01)、HR显著减慢(P<0.05),而依托咪酯组SBP、DBP、HR与诱导前比较无显著差异。气管插管后两组SBP、DBP和HR均上升,但与诱导前比较均无显著差异。组间比较,两组病人诱导后3m in,丙泊酚组SBP、DBP明显降于依托咪酯组(P<0.05)。结论:对心功能差的心脏瓣膜置换术患者,依托咪酯比丙泊酚诱导可获得平稳的血流动力学,有效地抑制插管时的心血管不良反应。

Effect of induction of anesthesia with etomidate and propofol on hemodynamics in patients undergoing cardiac valves replacement

Objective: To observe the clinical effects of induction of anesthesia with etomidate and propofol on hemodynamics in patients undergoing cardiac valves replacement.Methods: Fifty patients with cardiac function III subjected to cardiac valve replacement were randomly divided into group P(propofol,n=25) and group E(etomidate,n=25).Anesthesia was induced with propofol 2.5mg/kg in group P and with etomidate 0.3mg/kg in group E,and with vecuronium 0.15mg/kg and fentanyl 4μg/kg in two groups.The heart rate(HR),systolic and diastolic blood pressure(SBP and DBP),mean arterial blood pressure(MAP),central venous pressure(CVP) and SpO_2 were monitored and recorded immediately before the induction of anesthesia and 1 and 3 min thereafter,1min,3min and 5min after intubation.Results: There were no differences between groups at baseline.The administration of propofol and etomidate led to decreases in blood pressure and HR,but a significantly greater decrease of SBP,DBP and HR(P<0.01) was observed 3min after the administration of propofol compared with etomidate.SBP,DBP and HR were rebounded after tracheal intubation.Conclusion: The results of our study had shown that induction of anesthesia with etomidate may obtain smooth hemodynamics and effectively inhibit cardiovascular reactions caused by tracheal intubation in patients with bad cardiac function undergoing cardiac vavle replacement,compared to the induction doses of propofol.