胃镜检查术患者乳化依托咪酯-芬太尼咪达唑仑麻醉的效果

目的 评价胃镜检查术患者乳化依托咪酯.芬太尼-咪达唑仑麻醉的效果.方法 拟行胃镜检查术患者400例,年龄18～60岁,体重40～80 ks,ASA Ⅰ或Ⅱ级,随机分为4组:异丙酚复合芬太尼组(PF组)、乳化依托咪酯复合芬太尼组(EF组)、异丙酚-芬太尼-咪达唑仑组(PFM组)及乳化依托咪酯-芬太尼-咪达唑仑组(EFM组),每组100例.采用双盲法给药.静脉注射芬太尼或芬太尼-咪达唑仑0.1 ml/kg,随后静脉注射异丙酚或乳化依托咪酯1 ml/6 s,待患者睫毛反射消失后停止注射,行胃镜检查术,术中根据患者情况追加少量乳化依托咪酯或异丙酚,保留自主呼吸,面罩吸氧.记录麻醉诱导时间、胃镜检查时间、乳化依托咪酯用量、异丙酚用量、阿托品和麻黄碱使用情况、内镜医师和麻醉科医师对麻醉效果的满意程度及术后苏醒时间;记录术中体动、呼吸暂停、低氧血症、心动过缓、低血压、肌阵挛及术后有关并发症的发生情况.结果 与PF组和PFM组比较,EF组和EFM组苏醒时间延长,术中低氧血症、呼吸暂停、低血压及注射痛的发生率降低,术中最低血压值升高,麻黄碱使用率降低,术中肌阵挛发生率、术后恶心、呕吐及头晕的发生率及麻醉科医师满意程度升高(P＜0.05);与EF组比较,EFM组术中肌阵挛及术后恶心、呕吐、头晕的发生率降低,低血压发生率升高(P＜0.05).结论 乳化依托咪酯-芬太尼-咪达唑仑对胃镜检查术患者循环和呼吸功能的抑制程度较轻,术中及术后有关并发症发生率低.

Efficacy of etomidate combined with fentanyl-midazolam for gastroscopy

Objective To evaluate the efficacy of etomidate(etomidate-lipuro,B.Braun)combined with fentanyl-midazolam for gastroscopy.Methods Four hundred ASA ⅠorⅡ patients aged 18-60 yr weighing 40-80 kg undergoing gastroscopy were randomly divided into 4 groups(n=100 each):group Ⅰ propofol+fentanyl (PF);group Ⅱ etomidate+ fentanyl(EF);group Ⅲ propefol+fentanyl-midazolam(PFM)and group Ⅳ etomldate+ fentanyl-midasolam(EFM).The patients received one of the four anesthetic combinations in a double-blind fashion.Fentanyl(10 μg/ml)or fentanyl-midazofam mixture(fentanyl 10μg/ml+midazolam 0.2mg/ml)0.1 ml/kg was injected iv over 5-10 seconds followed by intravenous propofol(10 mg/ml)or etomidate(2mg/ml)at 1 ml/6 s until disappearance of eyelash reflex.Gastroscopy was performed.The patients were breathing spontaneously.Oxygen Was administered via face mask.Additional etomidate or propofol Wag given according to the patient's respome to surgical stimuli.The anesthesia induction time,gastroscopy time,the amount of etomidate and propofol administered,the number of cases in which atropine and/or ephedrine were used,the anesthetic efficacy assessed by anesthetist and endoscopist and recovery time were recorded.In addition intraoperative body movement,apnea,hypoxemia,bradycardia,hypotension,myoclonus,injection pain and postoperative complications were also recorded.Results The four groups were comparable with respect to age,sex ratio,body weight and gastroscopy time.The recovery time was longer,the incidences of intraoperative hypotension,apnea,hypoxemia and injection pain were significantly lower,the number of cases in which ephedrine was used was smaller but the incidences of myoclonus,postoperative nausea and vomiting and dizziness were significanfly higher in EF and EFM groups than in PF and PFM groups.Conclusion Etomidate combined with fentanyl-midazolam has less inhibitory effect on circulatory and respiratory function in patients undergoing gastroscopy and the incidences of intra-and posb operative complications are lower.