依托咪酯用于乳腺癌手术的麻醉效果及对患者应激水平和术后苏醒质量的影响

目的:探讨依托咪酯用于乳腺癌手术的麻醉效果及对患者应激水平和术后苏醒质量的影响。方法:选择我院2017年7月～2018年7月收治的93例乳腺癌患者,按随机数字表法分为对照组(43例)和研究组(50例),对照组予以丙泊酚静脉维持麻醉,研究组予以依托咪酯静脉维持麻醉,比较两组不同时点促肾上腺皮质激素(ACTH)、醛固酮、皮质醇水平、心率(HR)、舒张压(DBP)、收缩压(SBP)、Ramsay镇静评分,术后苏醒质量和不良反应的发生情况。结果:气管插管时,研究组ACTH浓度较麻醉诱导前上升,醛固酮、皮质醇浓度相应下降,对照组ACTH、醛固酮、皮质醇均较麻醉诱导前上升,组间差异有统计学意义(P0.05);术后24 h,两组ACTH、醛固酮、皮质醇较麻醉诱导前无统计学意义(P0.05);气管插管时,对照组HR、DBP、SBP均上升,研究组变化不明显,两组差异有统计学意义(P0.05);拔管后即刻,两组Ramsay评分较麻醉诱导前下降,组间比较差异无统计学意义(P0.05)。两组拔管时间、睁眼时间、定向力恢复时间比较差异无统计学意义(P0.05)。两组总不良反应发生率比较差异无统计学意义(P0.05)。结论:依托咪酯用于乳腺癌手术可获得良好的麻醉效果,能够抑制机体应激反应,维持血流动力学的稳定,术后苏醒质量满意,安全性高。

Anesthetic Effect of Etomidate for the Breast Cancer Surgery and its Effect on the Stress Level and Postoperative Recovery Quality

ABSTRACT Objective: To investigate the anesthetic effect of etomidate in breast cancer surgery and its effect on the stress level and postoperative recovery quality. Methods: 93 cases of breast cancer patients who were treated from July 2017 to July 2018 in our hospital were selected and divided into 43 cases of the control group and 50 cases of research group according to random number table method thoese patients, the control group was gived propofol intravenous maintenance anesthesia, while the research group was given etomidate intravenous maintenance anesthesia, the changes of serum adrenocorticotropic hormone (ACTH), aldosterone, cortisol levels, heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP), Ramsay sedation score before and after treatment, postoperative recovery quality and incidence of adverse reactions were compared berween two groups. Results: The endotracheal intubation, ACTH concentration in the research group was higher than that before anesthesia induction, the concentrations of aldosterone and cortisol decreased, ACTH, aldosterone, and cortisol in the control group were higher than those before induction of anesthesia(P<0.05); at 24 h after surgery, the serum ACTH, aldosterone and cortisol levels in the two groups shoed no significant difference(P>0.05). at the time of tracheal intubation, the HR, DBP and SBP of control group was increased, which showed no obvious difference compared with the research group(P<0.05). Immediately after extubation, the Ramsay scores of both groups were decreased before induction of anesthesia, and there was no significant difference between the two groups (P>0.05). there was no significant difference in the time of extubation, blinking time, incidence of total adverse reactions and recovery time between the two groups (P>0.05). Conclusion: Etomidate can be used for breast cancer surgery to obtain good anesthetic effect, it can inhibit the body''s stress response, maintain the hemodynamic stability, satisfactory quality of life after surgery.