依托咪酯和丙泊酚单一制剂在胃镜操作全麻方案的比较研究

目的 比较依托咪酯和丙泊酚单一制剂在全麻胃镜操作中的应用特点.方法 择期行胃镜检查术100例,用随机数字表法随机分为依托咪酯(E)组和丙泊酚(P)组,双盲法给药.E组静注依托咪酯0.3 mg/kg,术中胃镜置入时追加0.1 mg/kg.P组静注丙泊酚2.5 mg/kg,术中胃镜置入时追加1 mg/kg.Ramsay分级...

Comparative study of etomidate and propofol for gastroscopy

Objective To compare the application of etomidate and propofol in sedative gastroscopy.Methods 100 unpremedicated ASA Ⅰ-Ⅱ patients (age 18 years-85 years,weight 35 kg-85 kg) scheduled to elective gastroscopy under sedation were randomized into etomidate (E) group and propofol (P) group,50 cases in each group. Patients in the E group(n=50) received etomidate [0.3 mg/kg,injection time of (20 ± 5)s]intravenously. Additional doses (0.1 mg/kg) were given to keep the Ramsay sedation score(RSS) between 5 and 6 as needed. Patients in the P group(n=50) received propofol [2.5 mg/kg,injection time of (20± 5) s]intravenously. Additional doses (1 mg/kg) were given to keep the RSS between 5 and 6 as needed. The patients were administered 2L/mim oxygen through nasal catheter and maintained spontaneous ventilation during the procedure. The anesthesia induction time,sleeping time,recovery time and procedure time were recorded. Also,the mean arterial pressure (MAP),heart rate (HR) and oxygen saturation (SpO2%) were recorded at the time points of preanesthesia,falling asleep,3min postoperation respectively. In addition,intraoperative body movement,myoclonia,bucking and postoperative complications were also recorded.Results There was no significant difference between two groups in anesthetic potency,including the anesthesia induction time,sleeping time and recovery time (P＞0.05). MAP decreased significantly postoperatively in each group (P＜0.05),and the scale of decreasing in P group (23±16) was steeper than in E group (15±17)(P＜0.05). HR was also lower in P group than in E group postoperatively (P＜0.05).With respect to postoperative SpO2%,the scale of decreasing in P group (3.1±2.4)was steeper than in E group (2.1±2.0)(P＜0.05). The incidence of intraoperative body movement,myoclonia and bucking in E group (56%,54%,48%)were significantly higher than in P group(20%,4%,10%)(P＜0.05) respectively; however,there was significantly better satisfaction with the intraoperative muscle relaxation in P group (P＜0.05). The incidence of myoclonia was in negative correlation with age in E group.Conclusion Etomidate has less inhibitory effect on circulatory and respiratory function in patients but higher incidence of intraoperative body movement than propofol. For elderly patients,the incidence of these complications decreased with a reduced drug dosage.