| Objective To compare the clinical anesthesia effects of propofol,etomidate and propofol-etomidate combination in hysteroscopy operation.Methods Ninety ASA Ⅰ~Ⅱ patients,aged 20~60,body mass index less than 30 kg/m2,operation time less than 30 min,undergoing gynecological hysteroscopy operation were randomly divided into 3 groups(n=30): propofol group(group P),etomidate group(group E),etomidate plus propofol group(group EP).Each person was slowly given fentanyl 2 μg/kg by intravenous injection,2 minutes later,in group P,patients were injected propofol 1.5~2.5mg/kg at the speed of 300 ml/h for anesthesia induction,then propofol 4~8mg·kg-1·h-1 for anesthesia maintenance.In group E,patients were injected etomidate 0.25~0.35 mg/kg at the same speed for anesthesia induction,then etomidate 0.6~1.2 mg·kg-1·h-1 for anesthesia maintenance.In group EP,patients were injected etomidate 0.15 mg/kg plus propofol 0.5~1.0 mg/kg at the same speed for anesthesia induction,then propofol 4 ~8 mg·kg-1·h-1 for anesthesia maintenance.The changes of MAP,HR,SpO2 and RR were recorded at the following points: 5 minutes after the patients entering operating room(T0),patients being unconsciousness(T1),dilation of cervix(T2)and recovery(T3).The induction time,anesthesia time,operation time,recovery time,the time atPACU,the grade of anesthetic efficacy,the scores of SAS and BCS and the incidence of adverse reactions in each group were recorded.Results There was no significant difference in age and body mass index among the patients of three groups(P>0.05).In group P,the induction dosage of propofol was(1.7±0.3)mg/kg.In group E,the induction dosage of etomidate was(0.3±0.1)mg/kg.The induction dosage of group EP was etomidate 0.15mg/kg and propofol(0.6±0.2)mg/kg.The maintenance dosages of group P,group E and group EP respectively were propofol(134.3±60.9)mg,etomidate(20.3±8.2)mg and propofol(133.9±58.0)mg.There was no significant difference in maintenance dosage between group P and EP(P>0.05).The speed of induction time from fast to slow respectively was group EP,group E and group P(P<0.05).There was no significant difference in anesthesia time,operation time,recovery time and the time at PACU among three groups(P>0.05).There was no significant difference in MAP,SpO2,HR and RR at T0 among three groups(P>0.05).Compared with T0,the MAP at T1 and T2 in three groups decreased(P<0.05),but at T3 in group E and EP increased to the level of T0(P>0.05),and at T3 in group P was also lower(P<0.05).Compared with group P,The decrease of MAP at T1 and T2 in group E and EP were smaller(P<0.05).The HR was stable at T0,T1,T2 and T3 without significant difference among three groups(P>0.05).The SpO2 of group P at T1 was significantly lower than the time of T0 and the group E and EP(P<0.05).Compared with T0,the RR at T1 and T2 in three groups decreased(P<0.05).And in group P the RR at T1 decreased more significantly than that in group E and EP(P<0.05).There was no significant difference in MAP,SpO2 and RR at T1,T2 and T3 between group E and EP(P>0.05).Compared with group P,group E and EP had better anesthetic efficacy(P<0.05),but there was no significant difference betweengroup E and EP(P>0.05).The SAS and BCS scores did not indicate a significant difference among three groups(P>0.05).Compared with group P,the incidence of hypotension,respiratory depression,glossoptosis and injection pain was significantly lower in group E and EP(P<0.05),but there was no significant difference between group E and EP(P>0.05).The incidence of postoperative nausea and vomiting in group E was higher than that in group P and EP(P<0.05),but without significant difference between group P and EP(P>0.05).There was no significant difference in the incidence of bradycardia,myoclonus and postoperative agitation among three groups(P>0.05).No one had intraoperative awareness among three groups.Conclusion Etomidate combined with propofol on gynecological hysteroscopy operation is a more safe and comfortable regimen,which has a slight effect on respiratory and circulation system and less adverse reactions. |
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