摘要
目的探讨小剂量瑞芬太尼复合丙泊酚-依托咪酯麻醉在成人无痛胃镜中的效果及不良反应。方法将300例拟行无痛胃镜检查的成人患者,随机分成3组:小剂量瑞芬太尼复合丙泊酚组(P组)、小剂量瑞芬太尼复合依托咪酯组(E组)、小剂量瑞芬太尼复合丙泊酚-依托咪酯组(PE组)。P组先缓慢静注小剂量瑞芬太尼0.5μg/kg后,再缓慢推注丙泊酚1 mg/kg,待患者入睡,睫毛反射消失后行胃镜检查,必要时可单次追加丙泊酚20~30 mg。E组缓慢推注依托咪酯0.2 mg/kg,必要时单次追加4~6 mg,PE组缓慢推注丙泊酚0.5 mg/kg+依托咪酯0.1 mg/kg,必要时单次追加丙泊酚10~15 mg+依托咪酯2~3 mg,其他同P组。记录患者用药后起效时间、检查持续时间、患者苏醒时间、离开复苏室时间;麻醉前、入镜时、入镜后2 min、出镜时的收缩压;舒张压;心率;血氧饱和度;记录注射痛、肌颤、呕吐等不良事件,分别评定麻醉效果。结果 PE组、P组患者的苏醒时间及离开复苏室时间快于E组(P<0.05);PE组和E组患者入镜时、入镜后2 min、出镜时与麻醉前比较,收缩压、舒张压、心率、血氧饱和度差异无统计学意义;P组入镜时、入镜后2 min、出镜时的收缩压、舒张压、心率要明显低于麻醉前的指标,差异具有统计学定义(P<0.05);入镜时、入镜后2 min的血氧饱和度低于麻醉前(P<0.05);PE组检查过程中没有发生肌颤的患者,体动、需追加药物的患者及注射痛、心动过缓、低血压、缺氧等不良事件少于P组(P<0.05);PE组麻醉效果满意度整体优于P组和E组。结论小剂量瑞芬太尼复合丙泊酚-依托咪酯麻醉用于成人无痛胃镜检查安全可行,麻醉效果满意,能有效减少注射痛、呼吸循环抑制、肌颤等不良事件,值得临床上推广应用。
Objective To explore the feasibility of small doses of remifentanil plus propofol -etomidate anesthesia in adult painless gastroscopy, and observe the effect and adverse reactions. Methods A total of 300 adult patients of awaiting painless gastroscopy were randomly divided into 3 groups ： small doses of remifentanil plus propofol （P group）, small doses of remifentanil plus etomidate （E group）, and small doses of remifentanil plus Propofol -Etomidate （PE group）. Induction time, duration time, recovery time, time to leave recovery room and SBP, DBP,HR, SpO2 in T0 （prior to anesthesia）, T1 （at the time point of undergoing gastroscopy）, T2 （2 minutes after the gastroscopy）, T3 （at the time point of finished gastroscopy） were observed. Injection pain, muscular fibrillation, nausea and vomit, additional drugs were recorded to evaluate the anesthesia effect. Results Recovery time and time to leave recovery room of PE group and E group were shorter time. Among PE group and E group, differences of SBP, DBP,HR, SpO2 btween the T1, T2, T3 and the T0 were not significant （P〉0.05）. Incidence of injection pain, muscular fibrillation, nausea and vomit and additional drugs in PE group were lower （P〈0.05）. Satisfaction of anesthetist and gastroscopist with EP group was higher than that of P group （P〈0.05）. Conclusion Small doses of remifentanil plus propofol-etomidate anesthesia in adult painless gastroscopy is safe and satisfactory with a lower incidence of adverse reactions.It has a higher satisfaction of anesthetist and gastroscopist.
出处
《分子影像学杂志》
2018年第1期58-62,共5页
Journal of Molecular Imaging
关键词
无痛胃镜
瑞芬太尼
依托咪酯
丙泊酚
painless gastroscopy
remifentanil
etomidate
propofol
