摘要
目的比较依托咪酯和丙泊酚单一制剂在全麻胃镜操作中的应用特点。方法择期行胃镜检查术100例，用随机数字表法随机分为依托咪酯（E）组和丙泊酚（P）组，双盲法给药。E组静注依托咪酯0．3mg／kg，术中胃镜置入时追加0．1mg／kg。P组静注丙泊酚2．5mg／kg，术中胃镜置入时追加1mg／kg。Ramsay分级达到5-6级时行胃镜检查术。记录两组患者手术时间，诱导时间，镇静时间以及起坐时间。记录两组患者麻醉前、入睡时、术后平均动脉压（meanarterial pressure，MAP）、心率（heartrate，HR）及血氧饱和度（oxygen saturation，SpO：％）。记录两组患者术中体动、肌阵挛、呛咳，术后恶心、呕吐、肌痛等相关并发症的发生情况。，结果两组在麻醉效能方面的差异，包括诱导时间，镇静时间，起坐时间的差异均无统计学意义（P〉0．05）。循环影响方面，P组术前-术后MAP下降幅度为（23±16）mmHg（1mmHg=0．133kPa），显著大于E组的（15±17）mlnHg（P〈0．05），与E组比较，P组术后HR更慢（P〈0．05）。呼吸影响方面，P组SpO2％术后下降幅度为（3．1±2.4）％，显著大于E组的（2．1±2．0）％（P〈O．05）。E组术中体动、肌阵挛及呛咳的发生率分别为54％、56％及48％，显著高于P组的20％、4％及10％（P〈0．05），而P组术中肌松满意率则高于E组（P〈0．05）。E组肌阵挛发生率随年龄增高显著下降。结论依托咪酯对循环及呼吸的抑制作用小于丙泊酚，但肌阵挛、体动等发生率高。老年患者随着总体用药量的下降出现上述并发症的几率下降。
Objective To compare the application of etomidate and propofol in sedative gastroscopy. Methods 100 unpremedicated ASA I -Ⅱpatients （age 18 years-85 years,weight 35 kg-85 kg） scheduled to elective gastroscopy under sedation were randomized into etomidate （E） group and propofol （P） group, 50 cases in each group. Patients in the E group（n=50） received etomidate [0.3 mg/kg, injection time of （20 -＋ 5）s]intravenously. Additional doses （0.1 mg/kg） were given to keep the Ramsay sedation score（RSS） between 5 and 6 as needed. Patients in the P group（n=50） received propofol ~2.5 mg/kg, injection time of （20 ＋ 5） s]intravenously. Additional doses （1 mg/kg） were given to keep the RSS between 5 and 6 as needed. The patients were administered 2L/mim oxygen through nasal catheter and maintained spontaneous ventilation during the procedure. The anesthesia induction time, sleeping time, recovery time and procedure time were recorded. Also, the mean arterial pressure （MAP）, heart rate （HR） and oxygen saturation （SPO2%） were recorded at the time points of preanesthesia, falling asleep, 3min postoperation respectively. In addition, intraoperative body movement, myoclonia, bucking and postoperative complications were also recorded. Results There was no significant difference between two groups in anesthetic potency, including the anesthesia induction time, sleeping time and recovery time （P〉0.05）. MAP decreased significantly postoperatively in each group （P〈0.05）, and the scale of decreasing in P group （23-＋16） was steeper than in E group （15~17）（P〈0.05）. HR was also lower in P group than in E group postoperatively （P〈0.05）.With respect to postoperative SPO2%, the scale of decreasing in P group （3.1-＋2.4）was steeper than in E group （2.1-＋2.0）（P〈0.05）. The incidence of intraoperative body movement, myoclonia and bucking in E group （56%, 54%, 48%） were significantly higher than in P group（20%, 4%, 10% ）（P〈0.05 ） respectively; however, there was significantly better satisfaction with the intraoperative muscle relaxation in P group （P〈0.05）. The incidence of myoc｜onia was in negative correlation with age in E group. Conclusion Etomidate has less inhibitory effect on circulatory and respiratory function in patients but higher incidence of intraoperative body movement than propofol. For elderly patients, the incidence of these complications decreased with a reduced drug dosage.
出处
《国际麻醉学与复苏杂志》
CAS
2011年第1期44-47,共4页
International Journal of Anesthesiology and Resuscitation
