依托咪酯乳剂用于大容量肺灌洗术的效果观察(1)
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[摘要] 目的 观察依托咪酯乳剂应用于大容量肺灌洗术患者全身麻醉诱导、麻醉维持的效果。 方法 选取全身静脉麻醉下行双肺同期大容量肺灌洗术患者60例，平均分为E组和P组。全麻诱导E组用依托咪酯乳剂(0.3～0.6) mg/kg，P组用丙泊酚(2.0～4.0) mg/kg，全麻维持E组以依托咪酯乳剂(10～15) μg/(kg·min)、P组以丙泊酚(3～6) mg/(kg·h)持续泵入，其它麻醉诱导和维持用药相同。观察诱导过程中患者出现肌阵挛和注射痛的情况，记录入室T1、T2、T3、T4、T5时间点的血压、心率并进行数据分析，同时观察麻醉诱导中患者不良反应情况、停药后唤醒时间、拔管时间、定向力恢复时间。 结果 在T2、T4时间点时P组舒张压、收缩压、心率均高于E组，在T5时间点P组舒张压、收缩压低于E组(P<0.05)；唤醒时间P组较E组短(P<0.05)。 结论 依托咪酯乳剂在麻醉诱导和维持中比异丙酚具有血流动力学稳定性，使用临床剂量的依托咪酯乳剂作为大容量肺灌洗术麻醉诱导和术中维持的静脉全麻药是安全可行的。
[关键词] 依托咪酯乳剂；丙泊酚；全身麻醉；双腔支气管导管；大容量肺灌洗术
[中图分类号] R614.2+4 [文献标识码] B [文章编号] 1673-9701(2012)01-096-03
Observation on the effect of etomidate emulsion injection on whole lung lavage
LI Guofeng WANG Yuegang
Department of Anesthesiology, Occupational Disease Prevention Hospital of China Pingmei Shenma Group, Pingdingshan 467001, China
[Abstract] Objective To observe the effect of etomidate used in whole lung lavage during induction anesthesia and maintenance anesthesia. Methods All of 60 patients were divided into two groups of 30 each：etomidate group (group E) and propofol group (group P). The group E was induced (0.3-0.6) mg/kg and maintained (10-15) μg/ (kg·min) with etomidate, and the group P was induced (2.0-4.0) mg/kg and maintained (3.0-6.0) mg/(kg·h) with propofol. Recorded including muscle clonus, injection pain, blood pressure and heart rate of T1, T2, T3, T4, T5, adverse events, open eyes time, extubation time, directed recovery time. Results P groups of patients diastolic blood pressure, systolic blood pressure, and heart rate are higher than the group E In T2 and T4；In wake up time group P is shorter than group E (P<0.05). Conclusion Etomidate has a more stable hemodynamics than propofol during induction anesthesia and maintenance anesthesia. Etomidate use in whole lung lavage with clinical doses is safe and feasible.
[Key words] Etomidate; Propofol; General anesthesia; Double-lumen tube; Whole-lung lavage
肺灌洗作为尘肺病的一种治疗方法，最早于1982年由Mason首创。我国则于1986年由南京胸科医院谈光新教授最早采用[1]，并于1991年与中国煤矿工人北戴河疗养院共同创立了双肺同期大容量肺灌洗(whole-lung lavage，WLL)，该技术采用人工正压通气和负压吸引，有效地促进了灌洗液和有害物质尽可能多和尽可能快地排出体外[2] ......
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