在无痛胃镜检查中的临床应用研究l详解.pptVIP

讨论——椎管内麻醉 预肌注甲氧明0.3mg/kg可有效预防麻醉后血压下降 预注射甲氧明的循环稳定效果较血压下降后再静脉注射效果更好，恶心呕吐发生率更低 预注射甲氧明2mg不如3-4mg更能维持血压，但心率减慢几率增加 甲氧明2mg=麻黄碱10mg 讨论——全身麻醉 防治全麻诱导期血压下降，预防性注射甲氧明1.5mg效果满意 防治全麻诱导期血压下降，预防性注射4mg效果好，心率下降发生几率增加 纠正全麻诱导后血压下降，静脉使用甲氧明2-3mg效果良好，副作用少 讨论——日间麻醉 关于无痛胃肠镜检查患者低血压及 心律失常的发生率 关于日间麻醉甲氧明的使用 关于无痛胃肠镜诊疗中甲氧明的使用 目前此类研究尚少 实验结论 1、无痛胃肠镜麻醉中，患者术前存在不同程度循环血容量不足。在应用舒芬太尼和丙泊酚复合麻醉下，可能会出现循环抑制，特别是肠镜检查患者，低血压的发生率较高。重度低血压和循环抑制还可能造成严重心脏事件。严密观察、及时纠正低血压非常重要。 实验结论 2.甲氧明升压作用平和，效果确切，无痛胃肠镜检查麻醉诱导后静注甲氧明2mg/kg可预防低血压，使循环更平稳。 3.预防性使用甲氧明可减少麻黄碱等升压药的使用，减少恶心呕吐等并发症。 讨论—甲氧明副作用 心率减慢 容量不足时起效减缓 高血压持续状态 常见副作用 单次用量3mg，稀释后使用 必要时用阿托品 用药同时注意补充容量 必要时用肾上腺能α1受体阻滞药 酚妥拉明 总结 甲氧明较其它升压药有更多优势，特别适用于快速心率型低血压，使用安全方便 甲氧明2mg/kg静脉注射可用于无痛胃肠镜诊疗中低血压的预防和治疗，也可用于麻醉诱导期低血压防治 THANK YOU * 国外研究表明依托咪酯乳剂的注射痛发生率显著低于丙泊酚，这与两种药物本身的理化性质及其对溶媒的溶解性质有关。 Br J Anaesth. 2006; 97(4):536-9 Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. BACKGROUND: Propofol is associated with a high incidence of injection pain in children, even if given together with lidocaine. A new lipid formulation of etomidate (Etomidate-Lipuro) has been found in adults to cause very little discomfort during i.v. injection. The aim of the present prospective, double-blind, randomized trial was to compare the incidence of injection pain during i.v. induction of anaesthesia between propofol with added lidocaine (previous standard) and this new etomidate formulation in paediatric patients. METHODS: A total of 110 paediatric patients, aged 2-16 years, scheduled for outpatient surgery were planned to be included in the study. The primary end point of the study was the incidence of injection pain during induction of anaesthesia as assessed by a four-point scale as described previously. The occurrence of myoclonic muscular activity was registered as a secondary end point (four-point scale). An interim analysis after 80 patients was requested by the Ethics Committee. RESULTS: The study was stopped after the inclu