依托咪酯联合环泊酚全身麻醉对手术患者血流动力学和应激反应的影响

摘要/Abstract

摘要： 目的：观察依托咪酯联合环泊酚全身麻醉对手术患者血流动力学和应激反应的影响。方法：选择2021年1月至2021年12月在我院行全麻手术的患者92例，按照随机数字表法将患者分为观察组和对照组，每组各46例。对照组麻醉诱导和维持采用依托咪酯，观察组的麻醉诱导和维持采用依托咪酯联合环泊酚。观察两组患者手术相关指标和术后不良反应，比较两组患者舒张压、收缩压、心率和血氧饱和度（SpO2）在诱导前（T0）、诱导后1 min（T1）、插管后5 min（T2）和插管后10 min（T3）的动态变化，及手术前后血清去甲肾上腺素（NE）、皮质醇（Cor）、肾上腺素（E）、血栓素A2（TXA2）、血小板α颗粒膜蛋白140（GMP140）、脂质过氧化物（LPO）和谷胱甘肽过氧化物酶（GSH-Px）水平的变化。结果：两组患者的手术时长、术中出血量、麻醉时长和麻醉不良反应发生率差异无统计学意义（P>0.05）；观察组患者的术后自主呼吸恢复时间、术后苏醒时间和麻醉恢复室停留时间明显短于对照组（P<0.01）。在T1时点观察组患者的舒张压、收缩压和心率水平明显高于对照组（P<0.01），而其他各个时点的舒张压、收缩压、心率和SpO2水平两组差异无统计学意义（P>0.05）。两组患者术前血清NE、Cor、E、TXA2、GMP140、LPO和GSH-Px水平差异无统计学意义（P>0.05），术后两组患者血清NE、Cor、E、TXA2、GMP140和LPO水平较术前均升高（P<0.01），且对照组较观察组升高更明显（P<0.01）；而两组患者血清GSH-Px水平较术前降低（P<0.01），且对照组较观察组降低更明显（P<0.01）。结论：依托咪酯联合环泊酚全身麻醉对稳定手术患者血流动力学，降低患者应激反应、氧化损伤和血小板活性具有重要作用，且并不增加麻醉中的不良反应。

关键词: font-size:medium, ">依托咪酯；环泊酚；全身麻醉；血流动力学；应激反应

Abstract: Objective：To observe the effects of etomidate combined with ciprofol on hemodynamics and stress response of surgical patients undergoing general anesthesia. Methods：92 patients who underwent general anesthesia surgery in our hospital from January 2021 to December 2021 were divided into the observation group and the control group according to the random numbers method， with 46 cases in each group. Etomidate was used for induction and maintenance of anesthesia in the control group， and etomidate combined with ciprofol were used for the induction and maintenance of anesthesia in the observation group. The operation-related indicators and postoperative adverse reactions of the two groups of patients were observed. The diastolic blood pressure， systolic blood pressure， heart rate and blood oxygen saturation (SpO2) of the patients were compared between two groups at the point of before induction (T0)， 1 min after induction (T1)， 5 min after intubation (T2) and 10 min after intubation (T3)， and the levels of serum norepinephrine (NE)， cortisol (Cor)， epinephrine (E)， thromboxane A2 (TXA2)， platelet alpha granule membrane protein 140 (GMP140)， lipid peroxide (LPO) and glutathione peroxidase (GSH-Px) of the two groups of patients were compared before and after surgery. Results：There was no statistical difference in the operation duration， intraoperative blood loss， duration of anesthesia and incidence of adverse reactions to anesthesia between the two groups of patients (P>0.05). The postoperative recovery time of spontaneous respiration， awake time and anesthesia recovery room stay time of patients in the observation group were significantly shorter than those in the control group (P<0.01). At T1 time point， the levels of diastolic blood pressure， systolic blood pressure and heart rate of patients in the observation group were significantly higher than those in the control group (P<0.01)， and there was no statistical difference in the levels of diastolic blood pressure， systolic blood pressure， heart rate and SpO2 between the two groups of patients at other time points (P>0.05). There was no statistical difference in serum NE， Cor， E， TXA2， GMP140， LPO and GSH-Px levels between the two groups of patients before surgery (P>0.05). After surgery， the serum levels of NE， Cor， E， TXA2， GMP140 and LPO of the two groups of patients were all higher than those before surgery (P<0.01)， and the increase of the control group was more obvious than that of the observation group (P<0.01).The serum GSH-Px levels of the two groups of patients were all lower than those before surgery (P<0.01)， and the decrease of the control group was more obvious than that of the observation group (P<0.01). Conclusion：Etomidate combined with ciprofol plays an important role in stabilizing hemodynamics， reducing stress response， oxidative damage and platelet activity in surgical patients undergoing general anesthesia， and does not increase the adverse reactions during anesthesia.

Key words: font-size:medium, ">Etomidate； Ciprofol； General anesthesia； Hemodynamics； Stress response

中图分类号:

高玉蓓, 李寿春, 赵瑞珍, 翁浩. 依托咪酯联合环泊酚全身麻醉对手术患者血流动力学和应激反应的影响[J]. 中国医药导刊, 2023, 25(3): 297-302.

GAO Yubei, LI Shouchun, ZHAO Ruizhen, WENG Hao. Effects of Etomidate Combined with Ciprofol on Hemodynamics and Stress Response of Surgical Patients Undergoing General Anesthesia[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2023, 25(3): 297-302.

参考文献

[1]杨芳欣，曹伟. 全身麻醉联合硬膜外麻醉对宫颈癌手术患者血流动力学和应激反应及免疫系统的影响[J]. 中国肿瘤临床与康复， 2020， 27(7)： 821-823.
     [2]Nazemroaya B， Aghadavodi O， Honarmand A， et al. A comparative study of valsalva maneuver， lidocaine， and valsalva maneuvers with administration of lidocaine to reduce the pain associated with administration of etomidate during general anesthesia[J]. Anesth Pain Med， 2021， 11(3)： e113408.
     [3]刘璐. 环泊酚与小剂量右美托咪定复合麻醉对腹腔镜下子宫肌瘤切除术麻醉效果及术后应激反应的影响[J]. 实用妇科内分泌电子杂志，2022，9(19)：72-74.
     [4]Sridharan K， Sivaramakrishnan G. Comparison of fentanyl， remifentanil， sufentanil and alfentanil in combination with propofol for general anesthesia： a systematic review and meta-analysis of randomized controlled trials[J]. Curr Clin Pharmacol， 2019，14(2)： 116-124.
     [5]徐聪杰. 依托咪酯与丙泊酚用于骨盆骨折全麻效果比较[J]. 中国伤残医学， 2017， 25(7)： 36-37.
     [6]Nazemroaya B， Mousavi SM. Comparison of premedication with low-dose midazolam versus etomidate for reduction of etomidate-induced myoclonus during general anesthesia for electroconvulsive therapy： a randomized clinical trial[J]. Anesth Pain Med， 2019， 9(6)： e94388.
     [7]沈园园，蒋铭，王军，等. 七氟醚和丙泊酚对全身麻醉患者手术应激反应作用及血流动力学影响的Meta分析[J]. 中国医学工程， 2020， 28(3)： 1-9.
     [8]孙正琴，王强. 环泊酚用于无痛胃肠镜麻醉中的应用效果[J]. 科学养生， 2021，24(24)： 166.
     [9]廖秀珊，李耀松，何晓华，等. 超声引导下腰骶丛神经阻滞联合全身麻醉对老年髋关节置换术患者认知功能、氧化应激和血流动力学的影响[J]. 现代生物医学进展， 2021，21(9)： 1729-1733.
     [10]蒋筱扬，夏建国，原晓晖. 超声下椎旁神经阻滞复合全身麻醉对腹腔镜胆囊切除患者术中应激反应、血流动力学及术后疼痛的影响[J]. 中国医师杂志， 2021， 23(5)： 739-743.
     [11]徐超，沈昀. 丙泊酚、依托咪酯在卵巢癌全麻手术中的效果及对患者循环功能的影响[J]. 癌症进展， 2018，16(3)： 349-352.
     [12]宋莉，董雪，王旭莉，等. 腰椎旁神经阻滞联合全凭静脉全身麻醉对髋关节置换术患者血流动力学、应激反应、术后苏醒的影响[J]. 临床误诊误治， 2021， 34(2)： 69-73.
     [13]王永祥，蒋留琴，张元会. 不同剂量右美托咪定复合舒芬太尼对胸腰椎骨折全身麻醉患者血流动力学及应激反应的影响[J]. 海南医学， 2022，33(6)： 743-747.
     [14]彭要要，刘守知，张建国. 胸椎旁神经阻滞复合全身麻醉联合静脉自控镇痛对老年肺癌根治术患者血流动力学、氧化应激及细胞因子的影响[J]. 癌症进展， 2021， 19(20)： 2109-2113.
     [15]Meng Z， Gao C， Li X， et al. Effects of combined epidural anesthesia and general anesthesia on cognitive function and stress responses of elderly patients undergoing liver cancer durgery[J]. J Oncol， 2021， 2021： 8273722.
     [16]王永祥，蒋留琴，张元会. 不同剂量右美托咪定复合舒芬太尼对胸腰椎骨折全身麻醉患者血流动力学及应激反应的影响[J]. 海南医学， 2022， 33(6)： 743-747.
     [17]Wang CH， Luo J， Li J， et al. Efficacy of inhalational sevoflurane anesthesia induction on inhibiting the stress response to endotracheal intubation in children with congenital heart disease[J]. Eur Rev Med Pharmacol Sci， 2018， 22(4)： 1113-1117.
     [18]王政，赵民，杨保永，等. 丙泊酚全麻甲状腺手术患者血浆脂质过氧化物、GSH-Px和Cu-ZnSOD的变化[J]. 江苏医药， 2012， 38(8)： 948-949.
     [19]Zhang J， Gao J， Guo G， et al. Anesthesia and surgery induce delirium-like behavior in susceptible mice： the role of oxidative stress[J]. Am J Transl Res， 2018， 10(8)： 2435-2444.

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