上海交通大学学报（医学版）

上海交通大学学报（医学版）

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Narcotrend指导下依托咪酯用于持续静脉泵注的可行性

周珊珊，蓝海珍，董榕，于布为   

  1. 上海交通大学 医学院附属瑞金医院北院麻醉科， 上海 201801
  • 出版日期:2015-11-28 发布日期:2016-01-13
  • 通讯作者: 于布为, 电子信箱: yubuwei_2013@126.com。
  • 作者简介:周珊珊(1988—）， 女， 住院医师， 硕士; 电子信箱: saturday19880213@163.com。

Feasibility of continuous intravenous transfusion of etomidate monitored by Narcotrend

ZHOU Shan-shan, LAN Hai-zhen, DONG Rong, YU Bu-wei   

  1. Department of Anesthesiology,Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
  • Online:2015-11-28 Published:2016-01-13

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摘要：

目的  评价依托咪酯用于全身麻醉诱导及维持期间持续泵注的效果。方法  选择行全身麻醉的择期手术患者70例，ASAⅠ或Ⅱ级。麻醉诱导时，按一定顺序静脉注射给药（咪达唑仑0.03 mg/kg、依托咪酯0.3 mg/kg缓慢静注，继续给予舒芬太尼0.2 μg/kg及顺式阿曲库铵0.2 mg/kg），观察注射痛及肌阵挛的发生情况。麻醉维持期间，持续泵注依托咪酯10~15 μg/（kg·min），用Narcotrend监测仪监护麻醉深度，根据监测Narcotrend指数（NT值）调节泵注速度；静脉持续泵注瑞芬太尼0.1~0.2 μg/(kg·min)，间断追加顺式阿曲库铵维持肌松。分别于诱导前（T0）、诱导后1min（T1）、气管插管后即刻（T2）、手术开始（T3）、手术结束（T4）和拔管即刻（T5）记录平均动脉压（MAP）、心率（HR）及NT值。记录患者的手术时间、麻醉时间、术后苏醒时间、拔除气管导管时间和不良事件的发生情况；记录依托咪酯、顺式阿曲库铵和瑞芬太尼用量。结果  术中持续静脉输注依托咪酯10~15 μg/(kg·min)，患者NT水平基本维持在D1~D2级，NT值在40~60。与T0比较，T1时刻的NT值迅速下降达到插管要求，T1时刻MAP降低，但波动小于15%；在T5时刻，MAP和HR均明显升高。持续输注依托咪酯10~15 μg/（kg·min）可使大多数患者的NT值维持在理想水平。停药后多数患者16~22 min内NT值恢复至85（A~B1级）以上。诱导期间肌阵挛的发生率为14.3%。结论  依托咪酯用于ASA Ⅰ或Ⅱ级的成年患者麻醉诱导安全、迅速，血流动力学平稳；麻醉维持期间持续泵注依托咪酯速度为10~15 μg/（kg·min），可维持理想的麻醉深度，停药后苏醒迅速、完全，无苏醒延迟，且不良事件少。

关键词: Narcotrend, 依托咪酯, 持续静脉泵注, 麻醉深度

Abstract:

Objective  To evaluate the effects of etomidate on general anesthesia induction and continuous intravenous transfusion during maintenance. Methods  Seventy ASAⅠorⅡ patients undergoing selective operations and general anesthesia were enrolled. Anesthesia was induced with the order of intravenous injection of midazolam 0.03 mg/kg, etomidate 0.3 mg/kg, sufentanil 0.2 μg/kg, and cisatracurium 0.2 mg/kg. The injection pain and myoclonus during induction were recorded. During anesthesia maintenance, etomidate of 10-15 μg/(kg·min) was infused continuously and the depth of anesthesia was monitored by Narcotrend. Infusion speed was adjusted according to the Narcotrend index (NT value). During the operation, remifentanil was infused with the speed of 0.1-0.2 μg/(kg·min) and cisatracurium was injected at intervals. Mean artery pressure (MAP), heart rate (HR), and NT values were recorded before induction (T0), 1 min after induction (T1), endotracheal intubation (T2), the start and end of surgery (T3,T4), and extubation (T5). Surgery time, anesthesia time, awakening time after surgery, extubation time, and adverse events were recorded, as well as dosages of etomidate, cisatracurium, and remifentanil. Results  The NT level of patients maintained at D1-D2 grade with NT value of 40-60 by continuous intravenous infusion of etomidate of 10-15μg/(kg·min) during surgery. Compared with T0, the NT value at T1 decreased rapidly to meet the requirement of intubation. MAP at T1 decreased but the fluctuation was less than 15%. MAP and HR significantly increased at T5. NT values of most patients maintained at ideal level by continuous intravenous infusion of etomidate of 10-15μg/(kg·min). NT values of most patients recovered back to 85 (A-B1 grade) within 16-22 min after stopping transfusion of etomidate. The incidence of myoclonus during induction was 14.3%. Conclusion  Anesthesia induction of ASAⅠ or Ⅱ adult patients by etomidate is safe and quick and hemodynamics is stable. It can maintain ideal depth of anesthesia by continuous intravenous infusion of etomidate of 10-15 μg/(kg·min) during anesthesia maintenance. Patients wake up quickly and completely without delay after stopping transfusion and adverse events are rare.

Key words: Narcotrend, etomidate, continuous intravenous transfusion, depth of anesthesia