依托咪酯或丙泊酚对麻醉诱导过程中脑干功能的影响：脑电双频指数指导性研究

翻译：冯玉蓉  编辑：冯玉蓉  审校：曹莹

目的：比较依托咪酯和丙泊酚输注在麻醉诱导过程中对血流动力学参数、自主呼吸和角膜反射的影响。

方法：将80例成年患者随机分为两组——在麻醉诱导过程中输注依托咪酯(E组，40例)或丙泊酚(P组，40例)。在整个诱导过程中，监测患者的平均动脉压和心率。记录意识丧失时间(LOC)，以及意识丧失时的脑电双频指数(BIS)、是否存在自主呼吸和角膜反射。

结果：在麻醉诱导过程中，E组血流动力学参数变化小于P组。与丙泊酚相比，依托咪酯的平均LOC时间更短(129.5 s vs 189.5 s, P<0.0001)。LOC时E组的BIS低于P组(46.3 vs 52.9, P=0.0141)。LOC时E组保留自主呼吸的患者多于P组(80% vs 17.5%, P<0.0001)。同样，E组存在角膜反射的患者多于P组(34例vs 4例，P<0.0001)。依托咪酯诱发肌阵挛的发生率为17.5%。

结论：与丙泊酚静脉输注相比，依托咪酯输注在麻醉诱导时对患者血流动力学参数的影响较小。输注依托咪酯的患者在LOC时的BIS值较低，更多的患者存在自主呼吸和角膜反射。

文献来源：Zheng H, Zhu Y, Chen K, et al. The effect of etomidate or propofol on brainstem function during anesthesia induction: a bispectral index-guided study.[J]. Drug Des Devel Ther. 2020 Jun 5;13:1941-1946. doi: 10.2147/DDDT.S211523. eCollection 2020.

The effect of etomidate or propofol on brainstem function during anesthesia induction: a bispectral index-guided study

Abstract

Purpose: To compare the effect of etomidate versus propofol infusion on hemodynamic profiles, spontaneous breathing, and corneal reflex during the induction of anesthesia.

Methods: Adult patients (n=80) were randomized to receive etomidate (Group E, n=40) or propofol (Group P, n=40) infusion during anesthesia induction. Throughout induction, mean blood pressure and heart rate were monitored. Time to loss of consciousness (LOC), bispectral index (BIS), existence of spontaneous breathing, and corneal reflex at LOC were recorded.

Results: Fewer changes in hemodynamic profile occurred in Group E compared with Group P during induction of anesthesia. The mean time to LOC was shorter with etomidate than propofol (129.5 s vs 189.5 s, P<0.0001). BIS was lower in Group E compared with Group P at LOC (46.3 vs 52.9, P=0.0141). More patients exhibited spontaneous breathing in Group E compared with Group P at LOC (80% vs 17.5%, P<0.0001). Similarly, more patients maintained corneal reflex in Group E compared with Group P (34 patients vs 4 patients, P<0.0001). The incidence of etomidate-induced myoclonus was 17.5%.

Conclusion: Compared with propofol infusion, etomidate infusion during anesthesia induction had fewer effects on the hemodynamic profile of patients. Among patients who received etomidate, the BIS value was lower at LOC, and more patients displayed spontaneous breathing and corneal reflex.