行全髋置换术的老年患者血流动力学及肾上腺皮质功能影响

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Abstract To investigate the safety and feasibility of Etomidate administered by continuous infusion combined with lumbosacral plexus block in elderly patients undergoing total hip arthroplasty. Methods From January to December 2018, 102 elderly patients undergoing total hip arthroplasty in Baoshan Branch of Shanghai First People′s Hospital were randomly divided into the following groups: Propofol induction + Sevoflurane maintenance inhalation group (group A), Etomidate induction + maintenance infusion group (group B). Lumbosacral plexus block was performed in both groups before induction of general anesthesia. The recovery time, the use of deoxyepinephrine, etc. were recorded. Heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), and systemic vascular resistance (SVR) were measured and recorded before anesthesia induction (T1), after anesthesia induction (T2), at the beginning of operation (T3), before reaming cavity (T4), after femoral head prosthesis placement (T5), and at the end of operation (T6). The concentration of cortisol (COR) and adrenocorticotropic hormone (ACTH) were measured before anesthesia (t0), at the end of operation (t1), 24 h after operation (t2), 48 h after operation (t3). The occurrence of adverse reactions was recorded. Results There were 92 patients were enrolled in the study: 45 patients in group A and 47 patients in group B. There was no significant difference between the two groups in operative time, removal time of laryngeal mask after operation and bleeding volume (P > 0.05). The recovery time of group B was significantly longer than that of group A (P < 0.01). The number and total amount of deoxyepinephrine used in group A were significantly higher than those in group B (P < 0.01). There was no significant difference in HR and SV between the two groups at different time points during operation (P > 0.05). MAP and SVR were significantly higher in group B than in group A at T2-T5 (P < 0.01). MAP, SV and SVR in group A decreased at T2-T5 compared with T1 (P < 0.05), while MAP in group B decreased at T5 (P < 0.01). At t1, COR in group B was lower than that in group A (P < 0.01), and ACTH was higher than that in group A (P < 0.01). In group B, COR decreased at t1 compared with t0 (P < 0.01) and ACTH increased at t1 compared with t0 (P < 0.01). There was no significant difference in COR and ACTH in group A at t1-t3 (P > 0.05). The incidence of injection pain, post-operative restlessness and nausea and vomiting in group B were lower than that in group A (P < 0.05), but the incidence of myoclonus was higher than that in group A (P < 0.05). Conclusion Etomidate induction and maintenance has little effect on hemodynamics in elderly patients undergoing total hip arthroplasty on the basis of lumbosacral plexus block, the inhibition of Etomidate on adrenocortical function is transient. It is advantageous to anesthesia safety.

Key words： Etomidate Hemodynamics Continues infusion Arthroplasty Adrenal cortex hormones

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	GONG Wenyi1 XU Bing1 ZOU Feng2 YUE Xiaofang2 FAN Kun2

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GONG Wenyi1 XU Bing1 ZOU Feng2 YUE Xiaofang2 FAN Kun2. Effect of Etomidate continuous infusion on perioperative hemodynamics and adrenocortical function in elderly patients undergoing total hip arthroplasty combined with lumbosacral plexus block[J]. 中国医药导报, 2019, 16(31): 98-102.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I31/98

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