不同剂量羟考酮或舒芬太尼复合依托咪酯用于肝功能轻中度受损患者无痛胃镜检查  

Different Doses of Oxycodone or Sufentanil Combined with Etomidate in Painless Gastroscopy for Mild to Moderate Liver Impairment

作　　者：王建松[1] 王海霞 张杰[2] 崔林 王敏[4] Wang Jiansong;Wang Haixia;Zhang Jie;Cui Lin;Wang Min(Department of Anesthesiology,Fourth People's Hospital of Langfang City,Langfang 065700,Hebei,China;Endoscopy Division,Fourth People's Hospital of Langfang City,Langfang 065700,Hebei,China;Clinical Laboratory,Fourth People's Hospital of Langfang City,Langfang 065700,Hebei,China;Department of Pathology,Fourth People's Hospital of Langfang City,Langfang 065700,Hebei,China)

机构地区：[1]廊坊市第四人民医院/承德医学院附属医院麻醉科,河北廊坊065700 [2]廊坊市第四人民医院/承德医学院附属医院内镜科,河北廊坊065700 [3]廊坊市第四人民医院/承德医学院附属医院检验科,河北廊坊065700 [4]廊坊市第四人民医院/承德医学院附属医院病理科,河北廊坊065700

出　　处：《药物流行病学杂志》2021年第1期18-22,共5页Chinese Journal of Pharmacoepidemiology

基　　金：廊坊市科学技术研究与发展计划项目(编号:2019013029)。

摘　　要：目的:观察不同剂量羟考酮复合依托咪酯用于肝功能轻中度受损患者无痛胃镜检查的临床效果及安全性,并与舒芬太尼复合依托咪酯进行对比。方法:160例行无痛胃镜检查的肝功能轻中度受损患者随机分为A组、B组、C组及对照组,每组40例。A组、B组、C组分别静脉缓慢输注羟考酮0.05,0.075,0.1 mg·kg^(-1),对照组静脉缓慢输舒芬太尼注0.05μg·kg^(-1),3 min后4组分别静脉缓慢输注依托咪酯0.15 mg·kg^(-1)。观察4组患者麻醉前即刻(T0)、入睡呼之不醒(T1)、入镜1 min(T2)、出镜(T3)、苏醒即刻(T4)的平均动脉压(MAP)、心率(HR)及氧饱和度(SpO2)。记录4组依托咪酯总用量、追加依托咪酯例数、完全苏醒时长及药品不良反应发生情况。比较各组患者术前及术后7 d肝功能指标变化。结果:A、B、C 3组依托咪酯总用量、追加依托咪酯例数及完全苏醒时长均低于对照组(P<0.05), B组、C组依托咪酯总用量、追加依托咪酯例数及完全苏醒时长低于A组(P<0.05)。与T0时比较,各组T1~T3时的MAP、HR均明显下降(P<0.05)。与其他3组比较,对照组T2时MAP升高,T1时HR下降(P<0.05),4组不同时间点SpO2无明显变化(P>0.05)。A、B、C 3组恶心呕吐、肌阵挛发生率均低于对照组(P<0.05),且B组、C组恶心呕吐、肌阵挛发生率低于A组(P<0.05);C组呼吸抑制、头晕发生率高于其他3组(P<0.05)。4组患者术前和术后7d各项肝功能指标均无明显变化(P>0.05)。结论:羟考酮复合依托咪酯用于肝功能轻中度受损患者无痛胃镜检查的麻醉效果优于舒芬太尼复合依托咪酯,且安全性较高,羟考酮与依托咪酯复合用药的适宜剂量为0.075 mg·kg^(-1)。Objective:To observe the clinical efficacy and safety of different doses of oxycodone or sufentanil combined with etomidate in painless gastroscopy for mild to moderate liver impairment, and compared to the combination of oxycodone and etomidate.Methods:Totally 160 liver insufficiency patients with painless gastroscopy were divided randomly into group A, group B, group C and control group, with 40 patients in each group. Group A, group B and group C was injected slowly with 0.05, 0.075 and 0.1 mg·kg^(-1) oxycodone intravenously, the control group was slowly injected with 0.05 g·kg^(-1) sufentanil, and the four groups were injected slowly with etomidate 1.5 mg·kg^(-1) intravenously 3 min later. Mean arterial pressure(MAP), heart rate(HR) and oxygen saturation(SpO2) at immediate before anesthesia(T0), eyelash reflex disappeared(T1), 1 minute after the success of the endoscopic placement(T2), pulling the endoscope(T3), waking up(T4) were observed in the four groups. The usage amount of etomidate, additional number of etomidate, duration of complete waking and adverse drug reactions were recorded in the four groups. The indexes of liver function preoperative and postoperative 7 d in each group were compared.Results:Total etomidate dosage, cases of additional etomidate and total waking time in group A, group B and group C were lower than those in the control group(P<0.05), while total etomidate dosage, cases of additional etomidate and total waking time in group B and group C were lower than those in group A(P<0.05). Compared with those at T0, MAP and HR decreased significantly in each group from T1 to T3(P<0.05). Compared with those in group A, group B and group C, MAP in the control group increased at T2, HR at T1 decreased(P<0.05), and SpO2 showed no significant changes at different time points in the four groups(P>0.05). The incidence of nausea, vomiting and myoclonus in group A, group B and group C was lower than that in control group(P<0.05);the incidence of nausea, vomiting and myoclonus in group B and group

关 键 词：羟考酮 依托咪酯 舒芬太尼 无痛胃镜 肝功能轻中度受损 剂量 药品不良反应 

分 类 号：R971.2[医药卫生—药品]