Kling D, Russ W, Börner U, von Bormann B, Hempelmann G
Anasth Intensivther Notfallmed. 1985 Dec;20(6):325-9.
The results of experimental studies with etomidate demonstrating positive hemodynamic effects as well as a decrease in intracranial pressure induced a study using etomidate during cardiac surgery. This randomized study including 506 patients should prove the influence of etomidate on the rate of psychic disturbances after cardiac surgery. Patients treated with etomidate received a loading dose of 1 mg/kg b.w. etomidate within 15 minutes followed by a continuous infusion of 1 mg/kg b.w./h until the end of ECC. Patients without etomidate were the control group. Psychic disturbances were observed in 25% of the control group and in 30% of the etomidate group. In both groups of patients there was a fair number of patients with perioperative cardiopulmonary problems (artificial ventilation longer than 24 hours; catecholamine therapy: epinephrine greater than 5 micrograms/min longer than 3 hours): 8% in the control group and 20% in the etomidate group. These results indicate that etomidate does not beneficially influence the rate of psychic disturbances after open-heart surgery; it may induce, however, cardiopulmonary side effects after cardiac surgery. The results of recent studies indicating drug induced adrenal insufficiency are discussed.
依托咪酯的实验研究结果显示出积极的血流动力学效应以及颅内压降低，这促使人们开展了一项在心脏手术中使用依托咪酯的研究。这项纳入506例患者的随机研究旨在证明依托咪酯对心脏手术后精神障碍发生率的影响。接受依托咪酯治疗的患者在15分钟内静脉注射负荷剂量为1mg/kg体重的依托咪酯，随后持续输注1mg/kg体重/小时，直至体外循环结束。未使用依托咪酯的患者作为对照组。在对照组中，25%的患者出现了精神障碍，在依托咪酯组中这一比例为30%。两组患者中均有相当数量的患者存在围手术期心肺问题（人工通气时间超过24小时；儿茶酚胺治疗：肾上腺素剂量大于5微克/分钟且持续时间超过3小时）：对照组为8%，依托咪酯组为20%。这些结果表明，依托咪酯对心脏直视手术后精神障碍的发生率没有有益影响；然而，它可能会在心脏手术后诱发心肺副作用。文中还讨论了近期研究表明药物引起肾上腺功能不全的结果。
