丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响

doi:10.3760/cma.j.issn.1007-1245.2024.05.020

摘要/Abstract

摘要：

目的　比较丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响。方法　选取陕西中医药大学附属医院2022年6月至2023年8月收治的130例择期行骨科全麻手术老年患者进行随机对照试验，采用随机数字表法将其分为丙泊酚组（P组）与依托咪酯组（E组），各65例。P组麻醉诱导给予2.0 mg/kg丙泊酚，E组麻醉诱导给予0.3 mg/kg依托咪酯，分别联合舒芬太尼0.50 µg/kg、顺阿曲库铵0.15 mg/kg。插管完毕后立即采用Viby-Mogensen插管条件量表评价插管条件；记录麻醉诱导前（T₀）、丙泊酚/依托咪酯注射即刻（T₁）、喉镜置入后（T₂）、气管插管后1 min （T₃）、气管插管成功3 min （T₄）平均动脉压（MAP）、心率（HR）及心率压力乘积（RPP）；比较T₀、T₂、T₄时去甲肾上腺素（NE）、皮质醇（Cor）及血糖水平；比较两组丙泊酚或依托咪酯注射30 s内注射痛发生率、严重程度；比较两组气管插管时间。采用χ²检验、Mann-Whitney U检验、重复测量方差分析、t检验。结果　两组患者年龄、性别、体质量指数、ASA分级等基线资料比较，差异均无统计学意义（均P>0.05）。两组患者Viby-Mogensen插管条件量表的置入喉镜、声带位置、声带运动、气道反应及肢体反应分级比较，差异均无统计学意义（均P>0.05）。T₂、T₃、T₄时，E组MAP均高于P组，HR均低于P组，差异均有统计学意义（均P<0.05）。E组T₂时NE［（135.32±30.47）μg/L比（147.54±32.16）μg/L］、Cor［（68.39±14.12）ng/L比（76.17±14.65）ng/L］及血糖［（5.46±0.64）mmol/L比（6.04±0.76）mmol/L］均低于P组，差异均有统计学意义（均P<0.05）；E组T₃时NE［（154.69±33.42）μg/L比（170.35±36.30）μg/L］、Cor［（73.42±14.59）ng/L比（82.64±16.73）ng/L］及血糖［（6.72±0.95）mmol/L比（8.29±1.03） mmol/L］均低于P组，差异均有统计学意义（均P<0.05）。两组气管插管时间比较，差异无统计学意义（P>0.05）。E组注射痛发生率、注射痛得分均低于P组［17.46%（11/63）比56.67%（34/60）、0（0，1）分比1（0，1）分］，差异均有统计学意义（均P<0.05）。结论　0.3 mg/kg依托咪酯与2.0 mg/kg丙泊酚分别联合舒芬太尼0.50 µg/kg、顺阿曲库铵0.15 mg/kg在老年全麻可视喉镜气管插管中应用，气管插管条件相当，但依托咪酯诱导插管血流动力学更为平稳，应激反应及注射疼痛更轻微。

关键词:

丙泊酚, 依托咪酯, 老年全麻手术, 可视喉镜, 气管插管, 应激反应

Abstract:

Objective To explore the effects of propofol versus etomidate on laryngoscopic tracheal intubation conditions and stress response in elderly patients taking general anesthesia. Methods　One hundred and thirty elderly patients who underwent elective orthopedic surgery under general anesthesia at Hospital Affiliated to Shaanxi University of Chinese Medicine from June 2022 to August 2023 were selected for the randomized controlled trial. They were divided into a propofol group (group P) and an etomidate group (group E) by the random number table method, with 65 cases in each group. Group P took anesthesia induction by 2.0 mg/kg propofol, and group E by 0.3 mg/kg etomidate; both groups combined with 0.50 µg/kg sufentanil and 0.15 mg/kg cisatracurium. The intubation conditions were evaluated by the Viby-Mogensen Intubation Conditions Scale immediately after intubation. The meal artery pressure (MAP), heart rate (HR), and rate pressure product (RPP) were recorded before anesthesia induction (T₀), immediately after propofol/etomidate injection (T₁), after laryngoscope insertion (T₂), 1 min after tracheal intubation (T₃), and 3 min after successful tracheal intubation (T₄). The levels of norepinephrine (NE), cortisol (Cor), and blood glucose were compared at T₀, T₂, and T₄. The incidences and severities of injection pain within 30 s after propofol or etomidate injection were compared between the two groups. The tracheal intubation times were compared between the two groups. The χ² test, Mann-Whitney U test, tepeated measurement ANOVA, and t test were used. Results　There were no statistical differences in the basal line data, such as age, gender, body mass index, American Society of Anesthesiology (ASA) grading, etc., between the two groups (all P>0.05). There were no statistical differences in the laryngoscope insertion, vocal cord position, vocal cord movement, airway response, and limb response of the Viby-Mogensen Intubation Conditions Scale between the two groups (all P>0.05). The MAP's at T₂, T₃, and T₄ in group E were higher than those in group P; the HR's at T₂, T₃, and T₄ in group E were lower than those in group P; there were statistical differences (all P<0.05). The levels of NE [(135.32±30.47) μg/L vs. (147.54±32.16) μg/L], Cor [(68.39±14.12) ng/L vs. (76.17±14.65) ng/L], and blood glucose [(5.46±0.64) mmol/L vs. (6.04±0.76) mmol/L] at T₂ in group E were lower than in group P, with statistical differences (all P<0.05). The levels of NE [(154.69±33.42) μg/L vs. (170.35±36.30) μg/L], Cor [(73.42±14.59) ng/L vs. (82.64±16.73) ng/L], and blood glucose [(6.72±0.95) mmol/L vs. (8.29±1.03) mmol/L] T₃ in group E were lower than those in group P, with statistical differences (all P<0.05). There was no statistical difference in tracheal intubation time between the two groups (P>0.05). The incidence of injection pain and injection pain score in group E were lower than those in group P [17.46% (11/63) vs. 56.67% (34/60) and 0 (0, 1) vs. 1 (0, 1)], with statistical differences (both P<0.05). Conclusions　Application of 2.0 mg/kg propofol and 0.3 mg/kg etomidate combined with 0.50 µg/kg sufentanil and 0.15 mg/kg cisatracurium in laryngoscopic tracheal intubation of elderly patients taking general anesthesia both have comparable conditions for tracheal intubation, but the induction by etomidate has more stable hemodynamics, milder stress response, and less severe injection pain.

Key words:

Propofol, Etomidate, Surgery for elderly patients under general anesthesia, Laryngoscopy, Tracheal intubation, Stress response

何花丽朱明霞赵一凡单兆亚.

丙泊酚与依托咪酯对老年全麻可视喉镜气管插管条件及应激反应的影响 [J]. 国际医药卫生导报, 2024, 30(5): 802-808.

He Huali, Zhu Mingxia, Zhao Yifan, Shan Zhaoya.

Effects of propofol versus etomidate on laryngoscopic tracheal intubation conditions and stress response in elderly patients taking general anesthesia [J]. International Medicine and Health Guidance News, 2024, 30(5): 802-808.

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