心脏复律的麻醉：依托咪酯复合芬太尼与丙泊酚随机前瞻性比较

Anaesthesia for cardioversion: a prospective randomised comparison of propofol and etomidate combined with fentanyl.

机构信息

Department of Anaesthesiology, University of Crete, Heraklion, Greece.

出版信息

Hellenic J Cardiol. 2011 Nov-Dec;52(6):483-8.

Abstract

INTRODUCTION

External electrical cardioversion is mostly performed solely under sedatives or hypnotics, although the procedure is painful. The aim of this prospective randomised study was to compare two anaesthetic protocols that included analgesia.

METHODS

Patients with persistent atrial fibrillation were randomised to receive intravenously either fentanyl 50 μg and propofol 0.5 mg/kg (group P) or fentanyl 50 μg and etomidate 0.1 mg/kg (group E), while breathing spontaneously 100% oxygen. In the case of inadequate anaesthesia, repeated doses of 20 mg propofol (group P) or 4 mg etomidate (group E) were given as often as necessary until loss of eyelid reflex. Cardioversion was achieved with an extracardiac biphasic electrical shock ranging from 200 to 300 J, performed three times at most.

RESULTS

Forty-six patients (25 in group P, 21 in group E), aged 64 ± 9 years, were enrolled in the study. There were no differences between the study groups concerning left ventricular ejection fraction, the dimension of the left atrium, the number of shocks needed or the number of unsuccessful cardioversions. Patients in group E had a shorter time from injection of the induction agents until loss of consciousness (49 vs. 118 s, p=0.003) and until the first shock was given (61 vs. 135 s, p=0.004). Systolic blood pressure decreased significantly (repeated measurements ANOVA with Bonferroni adjustment) in group P when the baseline value was compared to that after anaesthesia induction (mean decrease 15.2 mmHg, 95% CI 5.6-24.8 mmHg, p=0.001) and to the value after recovery (mean decrease 15.2 mmHg, 95% CI 4.8-25.7 mmHg, p=0.002). Manual ventilation was required in 7 and 9 patients in groups P and E, respectively (p=0.360).

CONCLUSION

Both anaesthetic regimens provided excellent conditions for external electric cardioversion. In addition, etomidate in combination with fentanyl had a shorter induction time and ensured haemodynamic stability.

摘要

简介

体外电击复律大多仅在镇静或催眠下进行，尽管该过程会引起疼痛。本前瞻性随机研究的目的是比较两种包含镇痛的麻醉方案。

方法

持续性心房颤动患者随机接受静脉注射芬太尼 50 μg 和丙泊酚 0.5 mg/kg（P 组）或芬太尼 50 μg 和依托咪酯 0.1 mg/kg（E 组），同时 100%吸氧自主呼吸。如果麻醉不足，必要时反复给予 20 mg 丙泊酚（P 组）或 4 mg 依托咪酯（E 组），直至失去眼睑反射。使用最多 3 次 200-300 J 的体外双相电击进行复律。

结果

46 名患者（P 组 25 名，E 组 21 名），年龄 64±9 岁，入组本研究。研究组之间左心室射血分数、左心房大小、所需电击次数或复律失败次数无差异。E 组患者从注射诱导剂到意识丧失的时间（49 与 118 s，p=0.003）和到第一次电击的时间（61 与 135 s，p=0.004）更短。与麻醉诱导前相比，P 组收缩压显著下降（重复测量方差分析，Bonferroni 调整）（平均下降 15.2 mmHg，95%CI 5.6-24.8 mmHg，p=0.001），与恢复后相比也下降（平均下降 15.2 mmHg，95%CI 4.8-25.7 mmHg，p=0.002）。P 组和 E 组分别有 7 名和 9 名患者需要手动通气（p=0.360）。