CAJ | 학술논문

目的比较不同靶浓度依托咪酯-咪达唑仑-芬太尼-罗库溴铵麻醉诱导用于气管插管的效果.方法择期全身麻醉下行菲心脏手术患者80例,性别不限,年龄25 ～ 50岁,体重57 ～ 76 kg,ASA分级Ⅰ或Ⅱ级,Mallampati分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为4组(n=20),E0.5组、E0.7组、E0.9组和E1.1组依托咪酯效应室靶浓度分别为0.5、0.7、0.9、1.1μg/ml.静脉注射咪达唑仑0.05 mg/kg、芬太尼3μg/kg和罗库溴铵0.6 mg/kg后,靶控输注依托咪酯,4组当效应室浓度分别达0.5、0.7、0.9、1.1 μg/ml时开始气管插管.分别于麻醉诱导前(基础状态)、气管插管前即刻、喉镜置入时、气管插管后1、3、5 min时记录听觉诱发电位指数(AAI),记录麻醉诱导期间肌阵挛、注射痛、脑电爆发性抑制(BS)的发生情况和血管活性药物的使用情况.结果与E0.5组比较,E0.7组乌拉地尔使用率降低,E0.9组艾司洛尔和乌拉地尔使用率降低,BS发生率升高,E1.1组艾司洛尔和乌拉地尔使用率降低,阿托品和麻黄碱使用率及BS发生率升高(P＜0.05)；与E0.7组比较,E0.9组BS发生率升高,E1.1组阿托品使用率和BS发生率升高(P＜0.05)；与E0.9组比较,E1.1组BS发生率升高(P＜0.05),4组间AAI值、肌阵挛和注射痛的发生率差异无统计学意义(P＞0.05).结论复合咪达唑仑-芬太尼-罗库溴铵麻醉诱导时,依托咪酯的适宜靶浓度为0.7 μg/ml.
목적 비교불동파농도의탁미지-미체서륜-분태니-라고추안마취유도용우기관삽관적효과.방법 택기전신마취하행비심장수술환자80례,성별불한,년령25 ～ 50세,체중57 ～ 76 kg,ASA분급Ⅰ혹Ⅱ급,Mallampati분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환자수궤분위4조(n=20),E0.5조、E0.7조、E0.9조화E1.1조의탁미지효응실파농도분별위0.5、0.7、0.9、1.1μg/ml.정맥주사미체서륜0.05 mg/kg、분태니3μg/kg화라고추안0.6 mg/kg후,파공수주의탁미지,4조당효응실농도분별체0.5、0.7、0.9、1.1 μg/ml시개시기관삽관.분별우마취유도전(기출상태)、기관삽관전즉각、후경치입시、기관삽관후1、3、5 min시기록은각유발전위지수(AAI),기록마취유도기간기진련、주사통、뇌전폭발성억제(BS)적발생정황화혈관활성약물적사용정황.결과 여E0.5조비교,E0.7조오랍지이사용솔강저,E0.9조애사락이화오랍지이사용솔강저,BS발생솔승고,E1.1조애사락이화오랍지이사용솔강저,아탁품화마황감사용솔급BS발생솔승고(P＜0.05)；여E0.7조비교,E0.9조BS발생솔승고,E1.1조아탁품사용솔화BS발생솔승고(P＜0.05)；여E0.9조비교,E1.1조BS발생솔승고(P＜0.05),4조간AAI치、기진련화주사통적발생솔차이무통계학의의(P＞0.05).결론 복합미체서륜-분태니-라고추안마취유도시,의탁미지적괄의파농도위0.7 μg/ml.
Objective To compare the efficacy of different target concentrations of etomidate in combination with midazolam,fentanyl and rocuronium used to induce anesthesia for tracheal intubation.Methods Eighty ASA Ⅰ or Ⅱ and Mallampati Ⅰ or Ⅱ patients of both sexes,aged 25-50 yr,weighing 57-76 kg,scheduled for elective non-cardiac surgery under general anesthesia,were randomly allocated into 4 groups according to the target effect-site concentration of etomidate (n =20 each) ∶ 0.5 μg/ml group (group E0.5),0.7 μg/ml group (group E0.7),0.9μg/ml group (group E0.9) and 1.1 μg/ml group (group E1.1).The patients were unpremedicated.Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 3 μg/kg,rocuronium 0.6 mg/kg and etomidate given by target-controlled infusion.When the effect-site concentration of etomidate reached 0.5,0.7,0.9 or 1.1 μg/ml,endotracheal intubation was performed.Auditory evoked potential index was recorded before induction of anesthesia (baseline),immediately before intubation,during insertion of the laryngoscope,and at 1,3 and 5 min after intubation.Myoclonus,injection pain,the requirement for vasoactive agents and burst suppression (BS) were recorded during induction of anesthesia.Results Compared with group E0.5,the requirement for urapidil was significantly decreased in group E0.7,the requirement for esmolol and urapidil was significantly decreased and the incidence of BS was increased in group E0.9,the requirement for esmolol and urapidil was significantly decreased,and the requirement for atropine and ephedrine and incidence of BS were increased in group E1.1 (P ＜ 0.05).The incidence of BS was significantly higher in group E0.9,and the requirement for atropine and incidence of BS were significantly higher in group E1.1 than in group E0.7 (P ＜ 0.05).The incidence of BS was significantly higher in group E1.1 than in group E0.9 (P ＜ 0.05).There was no significant difference in auditory evoked potential index and incidences of myoclonus and injection pain among the four groups (P ＞ 0.05).Conclusion The optimum target concentration of etomidate is 0.7μg/ml when combined with midazolam,fentanyl and rocuronium used to induce anesthesia.