依托咪酯复合咪哒唑及芬太尼麻醉在无痛胃肠镜联合检查中的应用.docVIP

依托咪酯复合咪哒唑仑及芬太尼麻醉在无痛胃肠镜联合检查中的应用 裘剑波，林家燕，齐 超，孙 璐，陈明生 （解放军第113医院 麻醉科，浙江 宁波 315040） 摘要： 目的 探讨依托咪酯复合咪哒唑仑及芬太尼麻醉在无痛胃镜和肠镜联合检查中应用的麻醉效果和安全性。方法 120例无痛胃镜和结肠镜联合检查的患者，按抽签法随机分为依托咪酯复合组（E组，n=60）和丙泊酚复合组（P组，n=60）。依次静脉注射咪哒唑仑1~1.5mg，芬太尼0.05-0.07mg，丙泊酚1~1.5mg/kg或依托咪酯0.1~0.3mg/kg，待患者入睡，睫毛反射消失后开始胃镜检查，最后行结肠镜检查，检查中酌情追加小剂量依托咪酯或丙泊酚。记录两组患者镜检前、镜检即刻，置入镜后3、5、8、10和15min的SBP、DBP、HR、SpO2变化、苏醒时间和不良反应。结果 全部病例麻醉均满意，均顺利完成检查或治疗；苏醒时间E组（6.9±3.4）min，P组（6.1±2.9）min，E组苏醒时间比P组稍长，但两组差异无统计学意义（P＞0.05）。所有患者麻醉后血压和心率均有不同程度下降，其中血压下降超过基础血压的20%或＜90mmHg，P组14例（23.3%），E组5例（8.3%），两组比较有明显统计学差异（P＜0.01） ；患者心率低于55bpm以下，P组有8例（13.3%）E组2例（3.3%），两组比较有统计学差异（P＜0.05）。SpO2一过性低于90%，P组11例（18.3%），E组2例（3.3%），两组比较有明显统计学差异（P＜0.01）。E组2例轻微肌颤， P组无肌颤；恶心、呕吐P组有2例，E组有4例；两组比较差异无统计学意义（P＞0.05）。结论 依托咪酯复合咪哒唑仑及芬太尼麻醉在无痛胃肠镜联合检查中的麻醉效果是满意，临床上也是安全的。和丙泊酚比较而言，依托咪酯复合咪哒唑仑及芬太尼麻醉对呼吸和循环的影响更小，更适合无痛胃肠和肠镜联合检查术。 关键词：依托咪酯；丙泊酚；胃镜；结肠镜；联合检查 Comparison of etomidate and propofol combined with midazolam and fentanyl anesthesia in the treatment of elderly patients with painless colonoscopy QIU Jian-bo ,QI Chao ,LIN Jia-yan, LI Peng,CHEN Ming-sheng. (Department of Anesthesiology ,the 113th Hospital of PLA,Ningbo ,Zhejiang 315040, P.R,China) Abstract: 【Objective】Comparison the anesthetic effect and security of etomidate and propofol combined with midazolam and fentanyl anesthesia in the treatment of elderly patients with painless colonoscopy. 【Methods】120 cases of patients undergoing colonoscopy and treatment were randomly divided into two groups: Etomidate composite group (E group, n=60) and Propofol composite group (P group, n=60). In both groups, patients were given midazolam 1mg and fentanyl 0.03-0.05mg intravenously. Subsequently, P group patients were given propofol 1~1.5mg/kg intravenously while E group patients were given Etomidate 0.1~0.3mg/kg intravenously. After the patient to sleep and the lash reflex was abolished, we started the colonoscopy and treatment. Recording the awakening time, adverse reactions and changes in patient’s SBP, DBP, HR and SpO2 at the f