Effects Of Different Proportions Of Etomidate/propofol Mixture Or Propofol Monotherapy On Circulation And Prognosis Of Patients Undergoing Abdominal Endoscopic Surgery Under General Anesthesia

Objective To study the effects of different proportions of etomidate/propofol mixture and intravenous anesthesia with propofol alone on various physiological indicators and complications during and after abdominal endoscopic surgery,and to find the optimal proportion of etomidate/propofol mixture,so as to provide reference for clinical application.Method A total of 160 patients with abdominal endoscopic surgery under general anesthesia within 3 hours were selected,with ASA grade I/II,aged 20-60 years,and randomly divided into four groups:EP1:2,EP1:1,EP2:1,P（each group 40 cases）.All patients were fasted and fasted for 6 hours before surgery,and no preoperative drugs were given.After entering the room,monitor blood pressure,heart rate,blood oxygen saturation,and EEG dual-frequency index（BIS）.After establishing the venous access,push midazolam 1mg and start pumping dexmedetomidine with a loading dose of0.5-1μg/kg,Pumping time is 10min（in case of transient hypertension,the infusion rate can be slowed down）,then reduce the pump speed to the pump speed during anesthesia maintenance,the anesthesia maintenance pump speed is 0.2-0.7μg/kg·h,anesthesia induction is advanced Slowly give sufentanil 0.3-0.6μg/kg at 6 min,administration time 2 min,inject rocuronium 0.6 mg/kg 2.5 min in advance,1.5 min in advance EP1:2 group give etomidate 0.2ug/ml TCI,propofol 2ug/ml TCI;EP1:1group given etomidate 0.3ug/ml TCI,propofol 1.5ug/ml TCI;EP2:1 group given etomidate 0.4ug/ml TCI,C Propofol 1ug/ml TCI;Group P was given propofol3ug/ml TCI.After the patient’s eyelash reflex disappears,muscle relaxation is complete,and the effect of each induced drug reaches its peak,complete tracheal intubation and parallel mechanical ventilation,tidal volume 6-8ml/kg,adjust oxygen flow to 2L/min,and maintain end-tidal carbon dioxide at 35-45mm Hg Between;anesthesia maintenance EP1:2 groups give etomidate 0.2ug/ml TCI,propofol 2ug/ml TC;EP1:1 group give etomidate 0.3ug/ml TCI,propofol 1.5ug/ml TCI;EP2:1group was given etomidate 0.4ug/ml TCI,propofol 1ug/ml TCI;group P was given propofol3ug/ml TCI.The four groups maintained BIS 40-60,and adjusted the propofol and etomidate pump concentration according to the BIS value,and the four groups were infused with remifentanil 0.06-0.1μg/kg·min at the same time,according to the intraoperative blood flow The dynamic situation was supplemented with sufentanil,and the intra-abdominal pressure was maintained at 8-10mm Hg during the operation.Infusion of dexmedetomidine was stopped 40 minutes before the end of the operation.Antiemetics were routinely given during the operation.Sufentanil 5μg was used as the initial amount of postoperative analgesia 15 min before the end of the operation,and connected to the analgesic pump;the propofol/EP mixture was stopped 5-10 min before the end of the operation,and remifen was stopped at the end of the operation Tanny.Before discontinuing the drug,manually control the lung expansion at least3-5 times（APL valve 30 cm H₂O）.Recorded indicators:（1）General information:including gender,age,body mass index,ASA classification,operation time,anesthesia time,sufentanil dosage,and hospitalization days.（2）Average arterial pressure and heart rate at each time point:T₀--basic value,T₁--2min after induction,T₂--When cutting leather T₃--10min after operation T₄--1h after operation T₅--At the end of the operation T₆--2 min after extubation.（3）Use of vasoactive drugs.（4）Wake up situation and adverse reactions（waking time,extubation time,nausea and vomiting,RSAS score,OAA/S score,VAS score）.（5）Postoperative complications.Results At the same time point,the MAP in group EP1:2,group EP1:1 and group EP2:1 was higher than that in group P at time points from T₁ to T₉,and the difference was statistically significant（P<0.05）.In the same group,the time MAP was compared with the time point T₀,and the blood pressure was lower in the EP1:2 group and the EP1:1 group at the time point T₁-T₂（P<0.05）.Group EP2:1 had lower blood pressure at time T₁ and higher blood pressure at time T₃-T₅ with statistically significant differences（P<0.05）.The blood pressurep P of grou was lower in T₁-T₅,and the difference was statistically significant（P<0.05）.Heart rate at each time point:no statistical difference between EP1:2 group,EP1:1 group,and P group（P>0.05）;compared with P group,EP2:1 group has a faster heart rate from T₃ to T₅,with statistics Academic difference（P<0.05）;in the same group,the EP1:2 group,the EP1:1 group and the P group were lower at the T₁-T₅ time points compared with the T₀ time point,the difference was statistically significant（P<0.05）.Vasoactive drug EP2:1 group has a higher usage rate than P group,and the difference is statistically significant（P<0.05）;EP1:1 group and EP2:1 group have longer recovery time and extubation time than P group,The amount of sufentanil used was large,and the incidence of myoclonus,restlessness,nausea,and vomiting was high,and there were statistical differences（P<0.05）;the OAA/S score was higher in the EP2:1 group compared with the P group It is statistically significant（P<0.05）.There was no statistically significant difference in postoperative complications among the four groups（P>0.05）.Conclusions Different ratios of etomidate and propofol can maintain hemodynamic stability for general anesthesia maintenance;of which,etomidate 0.2ug/ml TCI combined with propofol 2ug/ml TCI and propofol alone are all intravenous Compared with anesthesia,intraoperative circulatory stability is better,and it is compatible with etomidate 0.3ug/ml TCI combined with propofol 1.5ug/ml TCI and etomidate0.4ug/ml TCI combined with propofol 1ug/ml TCI.In comparison,the postoperative recovery was stable,the extubation time was short,and the incidence of nausea and vomiting was low.