无痛肠镜的麻醉用药探讨

目的观察依托咪酯复合舒芬太尼用于无痛肠镜的临床效果及安全性。方法将2010年9月至2012年3月该院收治的80例自愿行无痛肠镜检查患者分为A组和B组,各40例,美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级。A组单独使用依托咪酯麻醉;B组检查前先给予枸橼酸舒芬太尼0.05μg/kg,2 min后再给予依托咪酯0.2-0.3 mg/kg进行麻醉。比较患者麻醉诱导开始前（T0）、诱导完成后（T1）、检查操作开始时（T2）、术毕时（T3）两组心率（HR）、血压、脉搏血氧饱和度（SpO2）、麻醉诱导时间、苏醒时间以及胃肠道反应、疼痛情况。结果 A组HR、血压诱导后T1时较T0时均有所下降,但均在正常范围之内;B组诱导后T1与T0时HR、血压比较,差异均无统计学意义（P〉0.05）;两组T1、T2时HR、血压均有所下降,与T0比较,差异均有统计学意义（P〈0.05）;在T1、T2时A组HR、血压均低于B组,差异有统计学意义（P〈0.05）;T0、T3时两组HR、血压比较,差异均无统计学意义（P〉0.05）。两组各时间点SpO2值比较,差异无统计学意义（P〉0.05）。A组依托咪酯用量（58.4±6.1）mg]高于B组（38.2±2.6）mg],差异有统计学意义（P〈0.05）;A组苏醒时间（7.9±5.6）min]长于B组（3.7±1.5）min],差异有统计学意义（P〈0.05）。两组患者在肠镜检查后发生恶心、呕吐方面比较,差异均无统计学意义（P〉0.05）;两组患者肠镜检查后疼痛比较,术后0.5 h及术后2.0 h疼痛B组明显优于A组,差异均有统计学意义（P〈0.05）。结论依托咪酯复合小剂量舒芬太尼用于无痛肠镜麻醉具有良好的镇痛效果及减少胃肠反应,是一种安全、有效的麻醉方法。

Exploration of anesthetics methods under painless colonoscopy

Objective To observe the clinical effects and safety of etomidate combined with sufentanil for painless colonoscopy. Methods A total of 80 patients underwent painless colonoscopy voluntarily were randomized into group A and group B,40 cases in each group from grade Ⅰ-grade Ⅱ according to the American Society of Anesthesiologists（ASA）. The group A used etomidate alone;while the group B was subject to 0.05 sufentanil citrate before examination,then narcotized by etomidate. The hear rate（HR）,blood pressure,saturation of pulse oximetry（SpO2）,gastrointestinal reaction and so on in the two groups were compared. Results After induction,the values of HR and blood pressure at T1were both lower than those at T0in group A both decreased,but both were within the normal range. The comparison on HR and blood pressure at T1and T0in group B after induction had no statistically significant difference（P〉0.05）;the values of HR and blood pressure at T1and T2in both groups were lower than those at T0with statistically significant difference（P〈0.05）;the values of HR and blood pressure at T1and T2in group A was both lower than those in group B with statistically significant difference（P〈0.05）;the comparison on HR and blood pressure in the two groups at T0and T3had no statistically significant difference（P〉0.05）. The comparison of SpO2value at different time in the two groups had no statistically significant difference（P〉0.05）. The dosage of etomidate in group A（58.4±6.1）mg] was obviously more than that in group B （38.2±2.6）mg] with statistically significant difference（P〈0.05）. The awakening time in group B（3.7± 1.5）min] was obviously shorter than that in group A（7.9±5.6）min] with statistically significant difference（P〈0.05）. The comparison between the two groups on nausea and vomiting after colonoscopy had no statistically significant difference（P〉0.05）. The pain in group 0.5 h and 2.0 h after surgery in group B was prior to that in group B with sta