依托咪酯与丙泊酚用于麻醉诱导的血流动力学特征：心脏手术患者的随机对照试验。

Haemodynamic profiles of etomidate vs propofol for induction of anaesthesia: a randomised controlled trial in patients undergoing cardiac surgery.

机构信息

Department of Pharmacology and Clinical Pharmacology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.

出版信息

Br J Anaesth. 2019 Feb;122(2):198-205. doi: 10.1016/j.bja.2018.09.027. Epub 2018 Nov 15.

DOI:10.1016/j.bja.2018.09.027

PMID:30686305

Abstract

BACKGROUND

Etomidate is frequently selected over propofol for induction of anaesthesia because of a putatively favourable haemodynamic profile, but data confirming this perception are limited.

METHODS

Patients undergoing cardiac surgery were randomised to induction of anaesthesia with propofol or etomidate. Phase I (n=75) was conducted as open-label, whereas Phase II (n=75) was double blind. Mean arterial blood pressure (MAP) and boluses of vasopressor administered after induction were recorded. The primary endpoint was the area under the curve below baseline MAP (MAP-time integral) during the 10 min after induction. Secondary endpoints were the use of vasopressors over the same period, and the effect of blinding on the aforementioned endpoints. Groups were compared using regression models with phase and anaesthetist as factors.

RESULTS

The mean difference between etomidate and propofol in the MAP-time integral below baseline was 2244 mm Hg s (95% confidence interval, 581-3906; P=0.009), representing a 34% greater reduction with propofol. Overall, vasopressors were used in 10/75 patients in the etomidate group vs 21/75 in the propofol group (P=0.38), and in 20/74 patients during the blinded phase vs 11/76 during the open-label phase (P=0.31). The interaction between randomisation and phase (open-labelled or blinded) was not significant for either primary (P=0.73) or secondary endpoints (P=0.90).

CONCLUSIONS

Propofol caused a 34% greater reduction in MAP-time integral from baseline after induction of anaesthesia than etomidate, despite more frequent use of vasopressors with propofol, confirming the superior haemodynamic profile of etomidate in this context. The proportion of patients receiving vasopressors increased slightly, albeit not significantly, in both groups in the blinded phase.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry, ACTRN12614000717651.

摘要

背景

依托咪酯因具有潜在的有利血流动力学特性而常被选用于麻醉诱导，而非丙泊酚，但证实这一观点的数据有限。

方法

择期行心脏手术的患者被随机分为丙泊酚或依托咪酯诱导麻醉。第一阶段（n=75）为开放标签，而第二阶段（n=75）为双盲。记录诱导后平均动脉压（MAP）和血管加压药的推注量。主要终点是诱导后 10 分钟内 MAP 基线以下的曲线下面积（MAP-时间积分）。次要终点是同一时期内血管加压药的使用情况，以及盲法对上述终点的影响。使用回归模型，以阶段和麻醉师为因素，对组间进行比较。

结果

依托咪酯与丙泊酚在 MAP-时间积分方面的差异为 2244 mm Hg·s（95%置信区间，581-3906；P=0.009），这意味着丙泊酚可使 MAP 降低 34%。总体而言，依托咪酯组有 10/75 例患者和丙泊酚组有 21/75 例患者使用了血管加压药（P=0.38），而在盲法阶段有 20/74 例患者和开放标签阶段有 11/76 例患者使用了血管加压药（P=0.31）。随机分组和阶段（开放标签或盲法）之间的交互作用对主要终点（P=0.73）和次要终点（P=0.90）均无显著影响。