舒芬太尼联合丙泊酚和依托咪酯作为胃镜检查术麻醉方案的可行性评估

目的评估舒芬太尼联合丙？白酚和依托咪酯作为胃镜检查术麻醉策略的优势及其可行性。方法240例胃镜检查患者随机分为三组，舒芬太尼＋丙泊酚组（丙泊酚组，I组，80例）、舒芬太尼＋依托咪酯组（依托咪酯组，Ⅱ组，80例）和舒芬太尼＋丙泊酚＋依托咪酯组（EP组，Ⅲ组，80例）。分别记录各组诱导时间、手术时间、镇静时间、苏醒时间；无创监测患者术前（注药前1—2rain），术中及术后（检查结束后1—2min）平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度；观察各组术中不良反应的发生率。结果在麻醉效果方面，三组的诱导时间、手术时间、苏醒时间、镇静时间之间差异无统计学意义（P〉0．05）；在血流动力学方面，与Ⅱ组和Ⅲ组相比较，I组术中和术后的MAP较低、术中HR较慢（P〈0．05）；在不良反应发生率方面，I组的术中氧饱和度低于90％的发生率高于Ⅱ组和Ⅲ组（P〈0．05）；II组的术中体动和肌颤、术后恶心呕吐的发生率高于I组和Ⅲ组（P〈0．05），嗜睡乏力的发生率高于I组；术中呛咳的发生率三组之间比较差异无统计学意义（P〉0．05）结论舒芬太尼联合丙泊酚＋依托咪酯更加适用于无痛胃镜检查，这种麻醉方案对循环和呼吸影响小，并且术中、术后的不良反应发生率较低。

Feasibility of sufentanil combined with propofol and etomidate for painless gastroscopy

Objective To evaluate the feasibility and superiority of sufentanil combined with propofol and etomidate as an anesthetic regimen for painless gastroscopy. Methods Totally 240 patients undergoing gastroscopy were divided into 3 groups randomly （n = 80 each） ： propofol group, etomidate group, propofol ＋ etomidate group （ EP group）. The induction time, operation time, sedation time and recovery time were recorded respectively. Mean arterial pressure（ MAP）, heart rate（HR） and SpO~ were detected in 1 -2 rain before and after surgery and during the procedure. The incidences of adverse reactions were observed in each group. Results The anesthetic effect, the induction time, operation time, sedation time and recovery time were not statistically different among three groups （P 〉 0.05 ）. The haemodynamics,the preoperative and postoperative MAP were lower and the intraoperative HR was slower in propofol group than in etomidate group and EP group（P 〈 0.05）. The incidence of SpO2 〈 90% in propofol group was higher than those in etomidate group and EP group （ P 〈 0.05 ）. The incidences of intraoperative body movement and myoclonus, postoperative nausea and vomiting were higher in etomidate group than those in propofol group and EP group（P 〈0.05 ） ,and the incidences of sleepiness and weakness were higher than that in propofol group（ P 〈 0.05 ）. The incidence of intraoperative bucking were not statistically different among 3 groups（ P 〉 O. 05）. Conclusion Sufentanil combined with propofol and etomidate in painless gastroscopy is a relatively reasonable regimen, which has a slight effect on respiratory system and circulation system and lower incidences of intraoperative and postoperative side effects.