依托咪酯联合地佐辛麻醉在肠镜检查术老年患者中的应用

目的：观察依托咪酯联合地佐辛用于老年无痛肠镜的麻醉效果。方法选择北海市人民医院2013年1~9月拟行无痛肠镜的老年患者120例，年龄65~84岁，ASAⅠ~Ⅱ级，体重41~68 kg，按照随机、双盲、对照的原则分为四组：丙泊酚-芬太尼组（A组）、丙泊酚-地佐辛组（B组）、依托咪酯-芬太尼组（C组）、依托咪酯-地佐辛组（D组），每组30例；静注芬太尼1μg/kg或地佐辛1μg/kg，随后静注丙泊酚或依托咪酯乳化剂1 mL/5 s。鼻导管给氧，保留自主呼吸。记录麻醉诱导时间，丙泊酚或依托咪酯给药量，注射痛、肌痉挛的情况，肠镜检查的时间，离室时间，术中呼吸抑制，低血压，麻黄碱、阿托品的给药量及体动情况、内镜医师和麻醉医师的满意度；麻醉前、术中最低的收缩压、舒张压、心率、血氧饱和度、呼吸；术后恶心、呕吐、头晕等并发症情况。结果四组患者的麻醉诱导时间、注射痛、肌痉挛、体动情况、内镜医师的满意度比较差异无统计学意义（P〉0.05）。与丙泊酚组（A、B组）比较，依托咪酯组（C、D组）患者术中呼吸抑制，低血压，麻黄碱、阿托品的给药量降低；麻醉医师的满意率增高；术中最低的收缩压、舒张压、心率、血氧饱和度、呼吸升高，术后恶心、呕吐、头晕等并发症增高；离室时间延长（P〈0.05）。与C组比较，D组患者呼吸抑制更低（P〈0.05）；D组术中呼吸与麻醉前比较差异无统计学意义（P〉0.05）。结论依托咪酯联合地佐辛麻醉虽然术后恶心、头晕等并发症多，但呼吸、循环影响小，适用于老年无痛肠镜。

Efficacy of Etomidate combined with Dezocine for colonoscopy of elderly patients

Objective To observe the anesthetic effect of indolent colonoscopy with Etomidate combined with Dezocine for elderly patients. Methods 120 elderly patients of Beihai People＇s Hospital from January to September 2013 sched-uled for indolent colonoscopy, ranging in age from 65 to 84, ASA Ⅰ-II, weight from 41 to 68 kg, were selected and divided into 4 groups according to the principle of random, control and double blinds： Propofol-Fentanyl （group A）, Propofol-Dezocine （group B）, Etomidate-Fentanyl （C group）, Etomidate-Dezocine （group D）, with 30 patients in each group. Intravenous Fentanyl 1μg/kg or Dezocine 1μg/kg was given, and then Propofol or Etomidate emulsifier 1 mL/5 s. Used nasal tube for oxygen provision, and kept spontaneous breathing. The time of anesthetic induction, dosage of Propofol or Etomidate, the state of injection pain and muscle spasm, the time of colonoscopy, departure time were recorded. During the surgery, respiratory depression, hypotension, dosage of ephedrine and atropine, body movement and the satisfaction of endoscopic physicians and anesthetist were also recorded. Meanwhile, less systolic pressure, di-astolic blood pressure, heart rate, oxyhemoglobin saturation and breathe before anesthetist and during the surgery and the complication after the surgery, such as nausea, emesis and dizziness, and so on were recorded. Results There were no statistical differences of induction time of anesthetic, injection pain, muscle spasm, body movement and the satisfac-tion of endoscope physicians in 4 groups patients （P〉 0.05）. Compared with Propofol group （group A, B）, respiratory depression, hypotension, dosage of ephedrine and atropine of Etomidate group （group C, D） were lower. Less systolic pressure, diastolic blood pressure, heart rate, oxyhemoglobin saturation, breath during the surgery were increased; the departure time was extended （P〈0.05）. Respiratory depression of group D, compared to group C, was lower （P〈0.05）;there was no difference of the