不同剂量丙泊酚减少老年患者胃肠镜检查术中依托咪酯所致肌阵挛的临床研究  

Clinical Study of Different Doses of Propofol in Reducing Myoclonus induced by Etomidate in Elderly Patients Undergoing Gastrointestinal Endoscopy

作　　者：张宁平 张琼 张宁丽 思永玉[4] 屈启才[4] ZHANG Ning-ping;ZHANG Qiong;ZHANG Ning-li;SI Yong-yu;QU Qi-cai(Kunming Special Service Convalesent Center of PLA,Kunming Yunnan 650307;Dept.of Anesthesiology,Xiangyun County People's Hospital,Xiangyun Yunnan 672100;Dept.of Anesthesiology,Yunnan Integrated Traditional Chinese and Western Medicine Hospital,Kunming Yunnan 650224;Dept.of Anesthesiology,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]中国人民解放军昆明特勤疗养中心,云南昆明650307 [2]祥云县人民医院麻醉科,云南祥云672100 [3]云南省中西医结合医院麻醉科,云南昆明650224 [4]昆明医科大学第二附属医院麻醉科,云南昆明650101

出　　处：《昆明医科大学学报》2020年第7期59-63,共5页Journal of Kunming Medical University

基　　金：国家重点研发计划项目(2018YFC0117205)。

摘　　要：目的观察不同剂量丙泊酚预处理减少老年患者胃肠镜检查术中依托咪酯所致肌阵挛的作用。方法选择80例在静脉麻醉下行胃肠镜检查的患者,年龄≥65岁,ASA Ⅰ-Ⅱ级,随机分为4组,每组20例,A组静注依托咪酯0.3 mg/kg,B、C、D组静注依托咪酯0.2 mg/kg前1 min分别静注丙泊酚0.3 mg/kg,0.6 mg/kg,0.8mg/kg,观察患者入室(T入室)、依托咪酯静注完毕(T0)、依托咪酯静注后1 min(T1min)、5 min(T5min)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏氧饱和度(SpO2)以及静注依托咪酯后肌阵挛发生情况及严重程度、呼吸抑制发生率等不良反应,比较胃肠镜检查时间、呼唤睁眼和定向力恢复时间。结果A、B、C、D组分别有15例、5例、2例、1例发生了肌阵挛,A组最高,差异有统计学意义(P<0.01);T0时点D组的MAP低于A、B、C三组,差异有统计学意义(P<0.05);A、B、C、D组分别有1例、2例、2例、7例SpO2低于90%,差异有统计学意义,D组发生率最高(P<0.05)。结论提前静注0.6 mg/kg丙泊酚,能明显减少老年患者胃肠镜检查术中依托咪酯诱发的肌阵挛,不良反应发生率低。Objective To observe the effect of different doses of propofol on the reduction of myoclonus induced by etomidate in elderly patients undergoing gastrointestinal endoscopy.Methods Eighty patients underwent gastrointestinal endoscopy under intravenous anesthesia,aged≥65 years,ASA Ⅰ-Ⅱ,were randomly divided into 4 groups,20 patients in each group.Group A received intravenous etomidate 0.3 mg/kg,and B,C,D groups injected etomidate 0.2 mg/kg 1 minute before injecting of 0.3 mg/kg,0.6 mg/kg,0.8 mg/kg propofol.We observed the mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO2)among the patient into the room(T into the room),etomidate intravenous injection(T0),1 minute(T1 min)and 5 min(T5 min)after injection of etomidate.Adverse reactions such as the occurrence and severity of myoclonus and the incidence of respiratory depression were compared,and the time of gastrointestinal endoscopy,awaking time and orientation recovery time were compared.Results In group A,B,C and D,myoclonus were occurred in 15 cases,5 cases,2 cases and 1 case,respectively,the difference was statistically significant(P<0.01).The MAP of group D in T0 time was lower than other groups,the difference was statistically significant(P<0.05).There were 1 case,2 cases,2 cases,7 cases in group A,B,C and D,respectively which SpO2 was less than 90%.The incidence of group D was the highest(P<0.05).Conclusion Intravenous injection of 0.6 mg/kg propofol can significantly reduce myoclonus induced by etomidate in elderly patients with gastrointestinal endoscopy,and the incidence of adverse reactions is low.

关 键 词：丙泊酚 依托咪酯 肌阵挛 胃肠镜检查 老年患者 

分 类 号：R614[医药卫生—麻醉学]