Comparison Of The Effects Of Propofol,etomidate And Propofol-etomidate Mixture On Hemodynamics And Cardiac Function In Patients

Objective:To clarify the effects of propofol,etomidate and propofol-etomidate mixture on patients’hemodynamics and cardiac function,thus providing reference for clinical general anesthesia.Methods:From June 2020 to December 2020,90 patients undergoing general anesthesia for non-cardiac surgery in The Fourth Hospital of Hebei Medical University were selected,they were randomly divided into 3 groups（n=30）:Group P（propofol group）,Group E（etomidate group）,and Group C（propofol-etomidate mixture group）.Inclusion criteria:American Society of Anesthesiologists（ASA）ClassificationⅠ～Ⅱ;patients undergoing general anesthesia;aged 18～65.Exclusion criteria:allergic to test medication;pregnant and lactating women;patients with mental illness,unable to cooperate with the operation of patients;severe liver and kidney failure or heart failure（NYHA cardiac functional grading≥III）;left ventricular ejection fraction（LVEF）<50%;BMI>30kg/m².Recorded the patient’s name,sex,age,height,weight,BMI and other general conditions.After entering the operating room,all patients were routinely monitored for electrocardiogram（ECG）,pulse oxygen saturation（SPO₂）,and bispectral index（BIS）.The left radial artery was punctured and placed under local anesthesia and the systolic blood pressure（SBP）,diastolic blood pressure（DBP）and mean arterial pressure（MAP）was monitored.Established a peripheral venous fluid route for infusion of Sodium Acetate Ringer Injection10ml/kg.Under local anesthesia,the right internal jugular vein catheterization were performed and the central venous pressure（CVP）was monitored.The HR,SPO_2,SBP,DBP,MAP,BIS and CVP were recorded before administration（T₀）and after administration 5 min（T₁）.All patients underwent transthoracic echocardiography before administration（T₀）and after administration 5 min（T₁）,recorded the stroke volume（SV）,cardiac output（CO）,left ventricular outflow tract（LVOT）blood left ventricular outflowtract（LVOT）blood flow velocity time integral（VTI）,peak velocity of early mitral annulus（Ea）,peak velocity of late mitral annulus（Aa）,and Ea/Aa and systemic vascular resistance（SVR）werecalculated.Thechangesof HR,MAP,CVP,SVR,SV,CO,LVEF,VTI and Ea/Aa before and after administration were recorded.The specific administration program was:gave the mask oxygen before and during the administration,the oxygen flow rate was 6 L/min.The specific plan was:Group P was infused with propofol 2mg/kg、Group E was infused with etomidate 0.3 mg/kg、Group C was infused with propofol and etomidate 1:1 volume mixture,which was propofol 1mg/kg and etomidate 0.2mg/kg.All drugs were continuously pumped by the micro pump at a speed of 4ml/kg·h.After the patient’s consciousness disappeared,the mandibular was lightly supported to assist ventilation.After ultrasound examination,intravenous injection of sufentanil 0.5μg/kg,cis-atracurium benzenesulfonic acid 0.12 mg/kg.The three groups were intratracheal intubation and ventilator after the effect of muscle relaxant.Results:1.Comparison among three groupsAfter administration,There was significant difference in MAP between the three groups（P<0.05）,The relationship between the three groups was Group P<Group C<Group E（P<0.01）;The CVP of Group P was greater than that of Group E（P<0.05）;The SVR of Group E was larger than that of Group P and Group C（P<0.05）.2.Comparison among three groups2.1Group PThe MAP,CVP and SVR decreased significantly after administration（P<0.01）,and the SV,CO,LVEF and VTI decreased（P<0.05）.2.2Group EThe CVP,SV,CO,VTI,and,Ea/Aa decreased after administration inductio-n,the difference was statistically significant（P<0.05）,while the SVR increased significantly（P<0.05）.2.3Group CThe MAP,CVP and SVR decreased significantly after administration induction（P<0.01）,and the LVEF,VTI decreased（P<0.05）.3.Comparison of changes before and after administration in three groups3.1Comparison of hemodynamicsΔMAP in Group E was different between Group P and Group C（P<0.05）,but there was no significant difference between Group P and Group C（P<0.05）.The difference ofΔCVP between Group P and Group E was statistically significant（P<0.05）.3.2Ultrasound comparisonThere was no significant difference inΔCO,ΔLVEF andΔEa/Aa between the three groups（P>0.05）.The difference ofΔSV andΔVTI between Group E and Group C was statistically significant（P<0.05）.Conclusions:After administration,propofol has maximum MAP volatility,Etomidate minimum,MAP volatility of propofol-etomidate mixture is between propofol and etomidate.Cardiac function index decreased in propofol group and etomidate group,the SV and CO of propofol group and etomidate group were not obvious.We think the mixture of propofol and etomidate 1:1 is safe and effective,And hemodynamic stability,Can better preserve the patient’s cardiac function.