比较双谱指数引导下丙泊酚、依托咪酯及依托咪酯-丙泊酚复合制剂用于儿科患者声门上气道装置置入的随机临床试验
Comparison of bispectral index-guided infusion of propofol, etomidate, and etomidate-propofol combination for supraglottic airway device insertion in paediatric patients: A randomised clinical trial.
文献信息
| PMID | 42820181 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Shreya Shah |
| 作者单位 | Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India. |
| 期刊 | Indian journal of anaesthesia |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景与目的： 声门上气道装置（SAD）在儿科中的应用已显著增加。本研究聚焦麻醉诱导期的血流动力学，评估丙泊酚（P）、依托咪酯（E）及依托咪酯-丙泊酚复合制剂（etofol，EP）组在达到双谱指数（BIS）50以置入SAD时的平均动脉压（MAP）变化。
方法： 共132例6至10岁、性别不限的患者随机分配至P组、E组和EP组，每组n=44。以50 mL/h输注组别特异性麻醉药物进行诱导，在BIS为50时置入SAD。主要结局为BIS 50时MAP较基线的变化（ΔMAP），次要结局包括心率变化（ΔHR）、达到BIS 50的时间、SAD相关参数（首次尝试成功率、置入时间、置入总评分）及药物相关副作用。
结果： P组ΔMAP最大，与E组和EP组相反（9.14 ± 1.5 对比 4.32 ± 0.98 和 4.75 ± 1.50 mmHg，P < 0.001）。E组与EP组之间ΔMAP相当，各研究组间ΔHR相当。P组和EP组的首次尝试成功率和置入总评分显著优于E组（90.9%和81.8% 对比 68.2%；P = 0.033，以及6.59 ± 0.97和6.84 ± 1.27 对比 7.80 ± 1.58；P < 0.001），尽管在P组与EP组之间分析时差异无统计学意义。P组和EP组的SAD置入时间较短，EP组分别相较于P组和E组表现出注射痛和肌阵挛的减轻。
结论： 依托咪酯-丙泊酚复合制剂（etofol）在BIS引导的儿科麻醉诱导中表现出更优的血流动力学稳定性，这是丙泊酚使用以确保良好SAD置入的额外优势，同时具有更好的副作用特征。
英文摘要
BACKGROUND AND AIMS: The use of supraglottic airway devices (SADs) in paediatrics has considerably increased. Focusing haemodynamics at anaesthetic induction, the study evaluated change in mean arterial pressure (MAP) amongst propofol (P), etomidate (E), and etomidate-propofol combination(etofol, EP) groups at the attainment of bispectral index (BIS) 50 for SAD insertion.
METHODS: A total of 132 patients of either gender between 6 and 10 years of age were randomly allocated as groups P, E, and EP with n = 44/group. Induced with a group-specific anaesthetic agent at 50 mL/h infusion, SAD was inserted at a BIS of 50. The primary outcome was change in MAP from baseline (∆MAP) at BIS 50, and secondary outcomes included change in heart rate (∆HR), time to attain BIS 50, SAD-related parameters (1st attempt success, time to insertion, insertion summed score), and drug-related side effects.
RESULTS: ∆MAP was maximum in group P opposed to groups E and EP (9.14 ± 1.5 versus 4.32 ± 0.98 and 4.75 ± 1.50 mmHg, P < 0.001). With comparable ∆ MAP between E and EP groups, ∆HR was comparable across the study groups. The 1st attempt success and insertion summed score were significantly better for P and EP groups compared to group E (90.9% and 81.8% versus 68.2%; P = 0.033 and 6.59 ± 0.97 and 6.84 ± 1.27 versus 7.80 ± 1.58; P < 0.001) albeit statistically insignificant when analysed between groups P and EP. Groups P and EP had lower SAD-insertion times with the EP group displaying attenuation of pain on injection and myoclonus in contrast to groups P and E, respectively.
CONCLUSION: Etomidate-propofol combination (etofol) demonstrated superior haemodynamic stability in BIS-guided paediatric anaesthetic induction, an added advantage to propofol use for ensuring favourable SAD insertion alongside better side-effect profile.