舒芬太尼复合依托咪酯清醒镇静镇痛在无痛电子胃镜检查中的应用  

Application of conscious sedation and analgesia with sufentanil combined with etomidate emulsion for painless gastroscopy

作　　者：胡峥嵘[1] 魏兵华[1] 李长科[1] 谭江波[2] 杨建华[1] 

机构地区：[1]汕头大学医学院附属粤北人民医院麻醉科,韶关512026 [2]南方医科大学附属珠江医院急诊科,广州510080

出　　处：《国际医药卫生导报》2013年第7期940-943,共4页International Medicine and Health Guidance News

摘　　要：目的研究舒芬太尼复合依托咪酯清醒镇静镇痛用于无痛胃镜检查中的有效性、安全性和可行性。方法选择ASAⅠ～Ⅱ级拟行无痛胃镜检查患者150例，随机分为三组：丙泊酚组（P组）、依托咪酯组（E组）、舒芬太尼复合依托咪酯组（SE组），各50例。P组：丙泊酚1．0～2．0mg／kg，E组：依托咪酯0．1～0．2mg／kg，DE组：舒芬太尼0．1μg／kg＋依托咪酯0．1mg／kg。各组均以60秒匀速静脉推注完毕。检查中均视患者体动情况给予适量缓慢静脉追加注射丙泊酚0．25～0．5mg／kg或依托咪酯0．025．0．05mg／kg。观察记录三组患者术前、术中的平均动脉压（MAP）、心率（HR）、经皮脉搏血氧饱和度（SPO，）；记录定向力恢复时间、恢复质量及肌阵挛、心动过缓、血压过低等不良反应情况。结果三组患者在不同时点的平均动脉压（MAP）、心率（HR）、经皮脉搏血氧饱和度（SP02）组间比较差异无统计学意义（P〉0．05），但与基础值比，P组T1、T2时点MAP、HR、SPO，下降明显，E组和sE组血流动力学明显比P组较平稳；三组定向力恢复时间和患者OAA／S评分结果比较，sE组和P组患者的神志恢复质量明显较E组好，患者术后嗜睡现象明显较少（P〈0．05），且恢复时间也较E组迅速，但差异无统计学意义（P〉0．05）；E组出现肌阵挛4例，而sE组和P组均不超过2例发生，肌阵挛发生率三组间差异有统计学意义（P〈0．05）。结论舒芬太尼复合依托咪酯清醒镇静镇痛用于无痛电子胃镜检查能达到满意的麻醉效果，且不良反应少，是一种安全、有效、可靠的麻醉方法。Objective To explore the effectiveness, safety and feasibility of conscious sedation and analgesia with sufentanil combined with etomidate for painless gastroscopy. Methods 150 ASA grade 1 to 2 patients scheduled for painless gastroscopy were randomly divided into three groups： propofol group （group P）, etomidate group （group E）, and sufentanil combined etomidate group （group SE）, 50 for each group. Group P received propofol of 1.0-2.0 mg/kg, group E received etomidate of 0.1-0.2 mg/kg, and group DE receievd propofol of 0.1mg/kg and etomidate of 0.1 Ix g/kg. All the intravenous injections were completed at a constant speed of 60 seconds. Additional intravenous injections of propofol 0.25-0.5 mg/kg or etomidate 0.025 - 0.05 mg/kg were administered based on body movements on examination in the patients. Preoperative and intraoperative average artery pressure （MAP）, heart rate （HR）, and percutaneous oxygen saturation （SPO2） were observed and noted. Time to orientation recovery and quality of recovery, and adverse reactions including myoclonus, bradycardia, and hypotension were noted. Results MAP, HR, and SPO2 at different time points did not differ significantly among the three groups （P〉0.05）. MAP, HR, and SPO2 decreased significantly group P at T1 and T2, as compared with the baselines; hemodynamics was more stable in groups E and SE than in group P. The quality of consciousness recovery was significantly better in groups SE and P than in group E based on orientation recovery time and OAA/S scores, postoperative somnolence was significantly less （P〈O.05）, and recovery time was shorter higher, but with no significant statistical differences （-P〉0.05）. 4 patients in group E occurred myoclonus whereas no more than 2 patients developed myoclonus in group P or SE, with a statistical significance （P〈0.05）. Conclusions Conscious sedation and analgesia with sufentanil plus etomidate for painless gastroscopy achieves a satisfactory anesthetic effect and has fewer adverse re

关 键 词：舒芬太尼 依托咪酯 清醒镇静镇痛 无痛电子胃镜 

分 类 号：R614[医药卫生—麻醉学]