比较依托咪酯与丙泊酚诱导全身麻醉在剖宫产术中的应用

Effect of etomidate and propofol in cesarean section under general anesthesia

摘要:

目的  比较依托咪酯与丙泊酚对全身麻醉剖宫产产妇血流动力学、意识和新生儿的影响。方法  选取70例全身麻醉下行剖宫产产妇，随机分为2组，即丙泊酚组（35例）：诱导剂量2 mg/kg，依托咪酯组（35例）：诱导量0.3 mg/kg。记录所有产妇麻醉诱导前（T0）、诱导后1 min（T1）、2 min（T2）及5 min（T3）时的心率（HR）、收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）以及血氧饱和度（SpO2）。记录并分析术前、术后（前10 min，1次/min，之后1次/5 min）、切皮、子宫切开、胎儿娩出、子宫缝合、皮肤缝合、睁眼和拔管时的脑电双频指数（BIS）等数据。结果  两组产妇基线资料差异无统计学意义。T2及T3时，依托咪酯组的SAP、DAP及MAP均高于丙泊酚组（P <0.05）。麻醉诱导后1～8 min以及切皮时、切子宫时、胎儿娩出时及气管拔管时，依托咪酯组的BIS值均低于丙泊酚组（P <0.05）。两组产妇手术时间、脐静脉血气值、新生儿APGAR评分、术后血流动力学、止痛效果及不良反应等差异均无统计学意义（P >0.05）。但依托咪酯组产妇复苏时间短于丙泊酚组，差异有统计学意义（P =0.036）。结论  依托咪酯较丙泊酚诱导全身麻醉对剖宫产产妇的血流动力学影响更小，安全性高，更适合剖宫产手术的全麻诱导，值得临床推广应用。

Abstract:

Objective To compare the hemodynamics, consciousness and neonatal effect of etomidate and propofol in cesarean section under general anesthesia. Methods A total of 70 puerpera with elective cesarean section under general anesthesia were randomly divided into 2 groups: propofol group (2 mg/kg) and etomidate group (0.3 mg/kg). The heart rate (HR), systolic pressure (SAP), diastolic pressure (DAP), mean arterial pressure (MAP) and oxyhemoglobin saturation (SpO2) at T0 (before anesthesia induction), T1 (1 min after induction), T2 (2 min after induction) and T3 (5 min after induction) were recorded. Results No significant differences in baseline data between the two groups were found. At T2 and T3, the SAP, DAP and MAP of etomidate group were significantly higher than those in propofol group (P < 0.05). The BIS values of the etomidate group were significantly lower than those of the propofol group at the 1st to 8th minute after the induction of anesthesia, the time of skin incision, hysterectomy, the fetus delivery and the trachea extubation (P < 0.05). There were no significant differences in operative time, umbilical vein blood gas, neonatal APGAR score, postoperative hemodynamics, analgesic effect and adverse reaction between the two groups (P > 0.05). However, the recovery time was shorter in the etomidate group than in the propofol group (P = 0.036). Conclusions Compared with propofol, etomidate has smaller effects on hemodynamics of cesarean section maternal under general anesthesia and is more suitable and safe for general anesthesia induction for cesarean section.