Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial
Anaesthetic induction with etomidate in cardiac surgery: A randomised controlled trial
复制标题
心脏手术中依托咪酯用于麻醉诱导：一项随机对照试验
DOI：
10.1097/eja.0000000000000434
复制
发表时间：
2016-06-01
影响因子：
3.6
通讯作者：
Eberle, Balthasar
中科院分区：
文献类型：
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作者：
Basciani, Reto M.;Rindlisbacher, Antje;Eberle, Balthasar
GROUNDEtomidate被认为在麻醉诱导期间保持血流动力学稳定。它也与肾上腺皮质功能障碍有关。风险/效益关系是有争议的。假设我们测试了单剂量依托咪酯增加累积血管加压药需求，拔管时间和ICU住院时间的假设。2006年11月至2009年12月，共90例患者接受冠状动脉旁路移植术（CABG），和40名接受二尖瓣手术（MVS）的患者。未入选的原因是已知的肾上腺皮质功能不全，术前1周内使用依托咪酯或丙泊酚，术前6个月内使用糖皮质激素，严重肾或肝功能障碍，或颈动脉狭窄。干预SCABG患者随机分配接受依托咪酯0.15mg/kg（-1）与安慰剂，异丙酚1.5mg/kg+安慰剂或依托咪酯0.15mg/kg+氢化可的松（每组n=30）。通过区组随机化实现风险分层（低与高）。MVS患者接受依托咪酯0.15mg/kg或丙泊酚1.5mg/kg（每组n=20）.主要结果测量累积的血管加压药需求，肾上腺皮质功能不全的发生率，拔管时间和ICU停留时间。在接受CABG的患者中，诱导后24小时的累积血管加压药需求在治疗之间没有差异，而MVS患者在丙泊酚诱导后使用了更多的去甲肾上腺素（24小时内绝对平均差异为5.86gkg（-1），P=0.047）。依托咪酯单用组相对肾上腺皮质功能不全的发生率高于丙泊酚组（CABG组83%对37%，P
BACKGROUNDEtomidate is perceived as preserving haemodynamic stability during induction of anaesthesia. It is also associated with adrenocortical dysfunction. The risk/benefit relationship is controversial.OBJECTIVESWe tested the hypotheses that single-dose etomidate increases cumulative vasopressor requirement, time to extubation and length of stay in the ICU.DESIGNDouble-blind randomised controlled trial.SETTINGBern University Hospital, Switzerland, from November 2006 to December 2009.PATIENTSThere were 90 patients undergoing coronary artery bypass grafts (CABG) and 40 patients undergoing mitral valve surgery (MVS). Reasons for noninclusion were known adrenocortical insufficiency, use of etomidate or propofol within 1 week preoperatively, use of glucocorticoids within 6 months preoperatively, severe renal or liver dysfunction, or carotid stenosis.INTERVENTIONSCABG patients were allocated randomly to receive either etomidate 0.15mgkg(-1) with placebo, propofol 1.5mgkg(-1) with placebo or etomidate 0.15mgkg(-1) with hydrocortisone (n=30 in each arm). Risk stratification (low vs. high) was achieved by block randomisation. MVS patients received either etomidate 0.15mgkg(-1) or propofol 1.5mgkg(-1) (n=20 in each arm).MAIN OUTCOME MEASURESCumulative vasopressor requirements, incidence of adrenocortical insufficiency, length of time to extubation and length of stay in ICU.RESULTSCumulative vasopressor requirements 24h after induction did not differ between treatments in patients who underwent CABG, whereas more noradrenaline was used in MVS patients following propofol induction (absolute mean difference 5.86gkg(-1) over 24h P=0.047). The incidence of relative adrenocortical insufficiency was higher after etomidate alone than propofol (CABG 83 vs. 37%, P