CAJ | 학술논문

目的评价依托咪酯靶控输注(TCI)复合瑞芬太尼用于妇科腹腔镜手术病人麻醉的效果.方法择期行妇科腹腔镜手术病人60例,年龄25 ～ 56岁,体重指数18 ～ 27 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组(n=30):TCI丙泊酚复合瑞芬太尼麻醉组(PR组)和TCI依托咪酯复合瑞芬太尼麻醉组(ER组).2组静脉注射咪达唑仑0.1 mg/kg、芬太尼4 μg/kg和顺阿曲库铵0.15 mg/kg麻醉诱导,PR组TCI丙泊酚,效应室靶浓度(Ce) 2.5 μg/ml,ER组TCI依托咪酯,Ce 0.8μg/ml,气管插管后行机械通气.麻醉维持:PR组TCI丙泊酚,Ce 2.0～ 2.5μg/ml,ER组TCI依托咪酯,Ce 0.5～0.7 μg/ml,2组静脉输注瑞芬太尼0.1～0.2μg·kg-1·min-1,间断静脉注射顺阿曲库铵5 mg,维持BIS值40 ～ 60.分别于术前(基础状态,T0)、术毕(T1)、术后24 h(T2)和术后48 h(T3)时采集静脉血样,测定血清皮质醇和醛固酮的浓度；记录苏醒时间、拔除气管导管时间和术中血管活性药物使用情况；记录麻醉诱导时注射痛和肌颤、术中知晓和术后躁动、恶心呕吐的发生情况.结果与T0时比较,T1时ER组血清皮质醇浓度降低(P＜0.05),2组各时点血清醛固酮浓度差异无统计学意义(P＞0.05).与PR组比较,ER组血管活性药物使用率和注射痛发生率降低,肌颤发生率升高(P＜0.05),苏醒时间、拔除气管导管时间、躁动和恶心呕吐发生率差异无统计学意义(P＞0.05).结论与TCI丙泊酚复合瑞芬太尼比较,TCI依托咪酯复合瑞芬太尼用于妇科腹腔镜手术时有助于维持血流动力学稳定,对肾上腺皮质功能的抑制作用是一过性的,注射痛发生较少.
목적 평개의탁미지파공수주(TCI)복합서분태니용우부과복강경수술병인마취적효과.방법 택기행부과복강경수술병인60례,년령25 ～ 56세,체중지수18 ～ 27 kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위2조(n=30):TCI병박분복합서분태니마취조(PR조)화TCI의탁미지복합서분태니마취조(ER조).2조정맥주사미체서륜0.1 mg/kg、분태니4 μg/kg화순아곡고안0.15 mg/kg마취유도,PR조TCI병박분,효응실파농도(Ce) 2.5 μg/ml,ER조TCI의탁미지,Ce 0.8μg/ml,기관삽관후행궤계통기.마취유지:PR조TCI병박분,Ce 2.0～ 2.5μg/ml,ER조TCI의탁미지,Ce 0.5～0.7 μg/ml,2조정맥수주서분태니0.1～0.2μg·kg-1·min-1,간단정맥주사순아곡고안5 mg,유지BIS치40 ～ 60.분별우술전(기출상태,T0)、술필(T1)、술후24 h(T2)화술후48 h(T3)시채집정맥혈양,측정혈청피질순화철고동적농도；기록소성시간、발제기관도관시간화술중혈관활성약물사용정황；기록마취유도시주사통화기전、술중지효화술후조동、악심구토적발생정황.결과 여T0시비교,T1시ER조혈청피질순농도강저(P＜0.05),2조각시점혈청철고동농도차이무통계학의의(P＞0.05).여PR조비교,ER조혈관활성약물사용솔화주사통발생솔강저,기전발생솔승고(P＜0.05),소성시간、발제기관도관시간、조동화악심구토발생솔차이무통계학의의(P＞0.05).결론 여TCI병박분복합서분태니비교,TCI의탁미지복합서분태니용우부과복강경수술시유조우유지혈류동역학은정,대신상선피질공능적억제작용시일과성적,주사통발생교소.
Objective To evaluate the anesthetic efficacy of etomidate target-controlled infusion (TCI) in combination with remifentanil in patients undergoing gynecological laparoscopy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 25-56 yr,with body mass index 18-27 kg/m2,undergoing elective gynecological lapa-roscopy,were equally and randomly divided into 2 groups:propofol TCI combined with remifentanil group (group PR) and etomidate TCI combined with remifentanil group (group ER).Anesthesia was induced with iv injection ofmidazolam 0.1 mg/kg,fentanyl 4 μg/kg and cisatracurium 0.15 mg/kg in both groups,and with TCI of propofolwith the target effect-site concentration (Ce) of 2.5 μg/ml in group PR or with TCI of etomidate (Ce 0.8 μg/ml) ingroup ER.The patients were mechanically ventilated after endotracheal intubation.Anesthesia was maintained withTCI of propofol (Ce 2.0-2.5 μg/ml) in group PR or with etomidate (Ce 0.5-0.7 μg/ml) in group ER,and with ivinfusion of remifentanil 0.1-0.2 μg· kg-1 · min-1 and intermittent iv boluses of cisatracurium 5 mg.BIS value was maintained at 40-60.Before anesthesia (baseline,T0),at the end of operation (T1),and at 24 and 48 h after operation (T2-3),venous blood samples were collected for determination of serum cortisol and aldosterone concentrations by radioimmunoassay.The emergence time,extubation time and requirement for vasoactive agents during operation were recorded.The development of injection pain and muscle twitch during induction of anesthesia,intraoperative awareness,and post-operative agitation,nausea and vomiting were also recorded.Results Compared with the baseline value at T0,the serum cortisol concentration was significantly decreased at T1 in group ER (P ＜0.05),while no significant change was found in serum aldosterone concentrations at each time point in the two groups (P ＞ 0.05).Compared with group PR,the requirement for vasoactive agents and incidence of injection pain were significantly decreased,and the incidence of muscle twitch was increased (P ＜ 0.05),and no significant change was found in the emergence time,extubation time,and incidences of post-operative agitation,nausea and vomiting in group ER (P ＞ 0.05).Conclusion Compared with propofol TCI in combination with remifentanil,etomidate TCI combined with remifentanil is helpful in maintaining the hemodynamics stable and exerts transient inhibition of adrenocortical function with less injection pain in patients undergoing gynecological laparoscopy.