依托咪酯与丙泊酚复合咪哒唑仑及芬太尼麻醉 在老年患者无痛结肠镜检查治疗中的比较

Comparison of etomidate and propofol combined with midazolam and fentanyl anesthesia in the treatment of elderly patients with painless colonoscopy

摘要:

目的 比较依托咪酯与丙泊酚复合咪哒唑仑及芬太尼麻醉在老年患者无痛结肠镜检查和治疗中的麻醉效果和安全性。方法 120例结肠镜检查和治疗的患者，按抽签法随机分为依托咪酯复合组（E组，n=60）和丙泊酚复合组（P组，n=60）。依次静脉注射咪哒唑仑1 mg，芬太尼0.03～0.05 mg，丙泊酚1～1.5 mg/kg或依托咪酯0.1～0.3 mg/kg，待患者入睡，睫毛反射消失后开始结肠镜检查和治疗。记录两组患者镜检前、镜检即刻，置入镜后3、5、8和10 min的SBP、DBP、HR、SPO2变化，苏醒时间和不良反应。结果 全部病例麻醉均满意，均顺利完成检查或治疗；苏醒时间E组（6.9±3.4）min，P组（6.1±2.9）min，E组苏醒时间比P组稍长，但两组差异无显著性（P >0.05）。所有患者麻醉后血压和心率均有不同程度下降，其中血压下降超过基础血压的20%或<90 mmHg，P组14例（23.3%），E组5例（8.3%），两组比较差异有显著性（P <0.01）；患者心率低于55 次/min以下，P组有8例（13.3%），E组2例（3.3%），两组比较差异有显著性（P <0.05）。SPO2一过性低于90%，P组11例（18.3%），E组2例（3.3%），两组比较差异有显著性（P <0.01）。E组2例轻微肌颤，P组无肌颤；恶心、呕吐P组有2例，E组有4例；两组比较差异无显著性（P >0.05）。结论 依托咪酯与丙泊酚复合咪哒唑仑及芬太尼麻醉在老年患者无痛结肠镜检查和治疗中的麻醉效果是满意的，临床上也是安全的。相比较而言，依托咪酯复合咪哒唑仑及芬太尼麻醉对呼吸和循环的影响更小，更适合老年患者无痛结肠镜检查和治疗。

Abstract:

【Objective】To compare the anesthetic effect and security of etomidate and propofol combined with midazolam and fentanyl anesthesia in the treatment of elderly patients with painless colonoscopy. 【Methods】 120 cases of patients undergoing colonoscopy and treatment were randomly divided into two groups: Etomidate composite group (E group, n =60) and Propofol composite group (P group, n =60). In both groups, patients were given midazolam 1mg and fentanyl 0.03~0.05 mg intravenously. Subsequently, P group patients were given propofol 1~1.5 mg/kg intravenously while E group patients were given Etomidate 0.1~0.3 mg/kg intravenously. After the patient slept and the lash reflex was abolished, we started the colonoscopy and treatment. The awakening time, adverse reactions and changes in patient’s SBP, DBP, HR and SpO2 were recorded at the following time points: before colonoscopy,colonoscopy instantly, 3 min, 5 min, 8 min, and 10 min after inserting the colonoscope. 【Results】 Both two groups of patients were satisfied with the anesthetic effect and successfully completed colonoscopy and treatment. The patient's awakening time in E group was (6.9±3.4) min, had no statistically significant difference than (6.1±2.9) min in the P group (P >0.05). Blood pressure and heart rate were decreased in all patients after anesthesia. In P group, there were 14 patients(23.3%) whose blood pressure were decreased by more than 20% of the basal blood pressure or lower than 90mmHg after anesthesia; while in E group only 5 patients(8.3%) happened. The two groups had statistically significant differences(P <0.01). There were 8 patients (13.3%) in P group with heart rate less than 55bpm after anesthesia, whereas in E group there were only 2 (3.3%) cases, which had a statistically significant difference compared with the P group(P <0.05). 11 patients(18.3%) in P group after anesthesia, whose SPO2 had a transient lower than 90%, however in E group only 2(3.3%) cases occurred. The two groups had statistically significant differences(P <0.01). Two patients in E group developed mild amyostasia, yet P group did not occur; 2 cases of patients in P group had symptoms of nausea and vomiting, while 4 cases occurred in E group. There was no statistically significant difference between the two groups (P >0.05). 【Conclusion】 Both etomidate and propofol combined with midazolam and fentanyl anesthesia in the treatment of elderly patients with painless colonoscopy can obtain a satisfactory anesthetic effect and be safe in clinical. However, in comparison, etomidate combined with midazolam and fentanyl anesthesia has smaller impact on the respiratory and circulatory, and more suitable for elderly patients with painless colonoscopy.