不同配比依托咪酯-丙泊酚混合液在无痛胃镜中的应用比较

摘要

目的 比较不同配比依托咪酯与丙泊酚(EP)混合液在无痛胃镜检查中的麻醉效果、安全性和不良反应.方法 选择拟行无痛胃镜检查患者200例,男95例,女105例,年龄18~65岁,BMI 18.5~27.0 kg/m2,ASA Ⅰ或Ⅱ级,随机分为两组.A组予以依托咪酯20 mg配比1%丙泊酚100 mg,容量比1:1;B组予以依托咪酯20 mg 配比1%丙泊酚200 mg,容量比1:2,每组100例.所有患者在胃镜检查前2 min 予以舒芬太尼0.1 μg/kg 缓慢静注,EP 混合液首次剂量予以0.15~0.2 ml/kg缓慢静注,根据患者镇静深度单次予以1~2 ml 追加.所有患者入室后持续监测HR、SBP、DBP和 SpO2,记录依托咪酯用量和丙泊酚用量.记录两组药物起效时间、操作时间、苏醒时间和离室时间.记录两组低血压、心动过缓、低氧血症、注射痛、肌颤、恶心呕吐等不良反应.结果 A组术中依托咪酯用量明显多于B组(P<0.01),丙泊酚用量明显少于B组(P<0.05);两组的药物起效时间、操作时间、苏醒时间、离室时间差异均无统计学意义.A组术中肌颤发生率明显高于B组(P<0.01);A组恶心呕吐发生率明显高于B组(P<0.05).两组低血压、低氧血症和注射痛等不良反应发生率差异无统计学意义.结论 与1:1的 EP 混合液比较,1:2的 EP 混合液肌颤和恶心呕吐发生率较低,更适合于胃镜检查.%Objective To compare the anesthetic effects,safety and side effects of the mixture with different ratios of etomidate to propofol in painless gastroscopy.Methods Two hundred patients scheduled for painless gastroscopy,95 males and 105 females,aged 18 to 65 years,BMI 18.5-27.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomized into two groups,group A (the ratio of eto-midate and propofol volume 1:1);group B (the ratio of etomidate and propofol volume 1:2).All of the patients were injected with sufentanil 0.1 μg/kg at first.All patients were given the first dose of 0.15-0.2 ml/kg intravenously slowly.Repeated doses of 1-2 ml etomidate-propofol were administered to maintain an adequate level of sedation.HR,SBP,DBP and SpO2were monitored.The dosages of etomidate and propofol were recorded.At the same time the induction time,the operation time,the recovery time and the leaving time were recorded.And low blood pressure,hypoxia saturation,re-spiratory obstruction,muscle fibrillation,nausea and vomiting and other adverse reactions were re-corded.Results There was no significant difference between group A and group B in the induction time,the operation time,the recovery time,the leaving time,perioperative hypotension,periopera-tive hypoxia and injection pain.The dosage of etomidate in the group A was significantly more than in the group B (P<0.01).The dosage of propofol in the group A was significantly less than in the group B(P<0.05).The incidence of myoclonus in group A was notably higher than that in the group B (P<0.01),The incidence of nausea and vomiting in group A was higher than that in the group B (P<0.05).Conclusion Etomidate plus propofol (1:2)had less incidence of myoclonus and nausea and vomiting,and it is more suitable for gastroscopy than 1:1 EP mixture.