瑞芬太尼联合依托咪酯麻醉在小儿胃肠镜检查中安全性和有效性观察

目的：观察瑞芬太尼联合依托咪酯复合麻醉用于小儿无痛胃肠镜检查中的安全性和有效性。方法：行胃肠镜检查或治疗的患儿120例（ASA1－Ⅱ级），随机分为瑞芬太尼联合依托咪酯组（RE组）和氯胺酮联合依托咪酯组（KE组）各60例。2组均静脉给予依托咪酯2mg／kg，待患儿入睡后，RE组以瑞芬太尼0．1μg／（kg·min）和依托咪酯0．3μg（kg·min）泵注维持。KE组以氯胺酮20μg／（kg·min）和依托咪酯0．3μg／（kg·min）泵注维持麻醉．对比观察2组患儿麻醉中平均动脉压（MAP）、心率（HR）、呼吸（RR）、脉搏氧饱和度（SpO，）情况，清醒和恢复时间，镇静效果，不良反应等。结果：RE组患儿胃肠镜置入前及置入后5min MAP、HR改变无明显变化（P〉0．05），KE组置入后5minMAP升高，HR增快，与RE组比较差异有统计学意义（P〈0．05）；镇静质量模拟评分（VAS）评分≤2分者，RE组为52例，KE组为41例，RE组高于KE组（P〈0．05），RE组苏醒时间和恢复时间明显短于KE组，两组比较差异有统计学意义（P〈0．01或P〈0．05）。结论：瑞芬太尼联合依托咪酯可安全地用于小儿无痛胃肠镜检查，和氯胺酮联合依托咪酯比较，瑞芬太尼联合依托咪酯麻醉组术中血流动力学指标更平稳，苏醒及恢复更快，术中及术后不良反应相对较少。

Efficacy and safety of combined anesthesia using remifentanil and etomidate in children underwent gastrointestinal endoscopy

Objective： To assess the efficacy and safety of combined anesthesia using remifentanil and etomidate on children who underwent gastrointestinal endoscopy. Methods：A total of 120 children （ASA I-II） who underwent gastrointestinal endoscopy consecutively for diagnosis and treatment were recruited and were randomly assigned to receive combined remifentanil and etomidate （group RE,n = 60） or combined ketamine and etomidate （ group KE, n = 60） intravenous injection, respectively. Both groups were given etomidate （ 2 mg/kg） injection intravenously till asleep. This was followed by intravenous injection of combined remifentanil 0. 1 μg/（ kg min） ] and etomidate 0.3 μg/（ kg . min） ] in group RE or combined ketamine 20 μg/（ kg .min） ] and etomidate 0.3 μg/（kg. min）] injection intravenously in group KE via injection pumps for maintenance of anesthesia, respectively. Mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR）, oxygen saturation （ SpO2 ）, time to consciousness and recovery, quality of sedation and adverse reactions in children of both groups were compared. Results：Group RE did not yield significant alteration in MAP and HR prior to and 5 minutes after positioning of gastrointestinal endoscopes （ both P 〉 0.05 ）. Contrarily, there was a marked increase in MAP and HR in group KE （ both P 〈 0.05 ） as compared with group RE. Group RE （52 cases） was associated with a higher number of children （P 〈 0.05） as having sedation quality simulated scale （VAS） ≤ 2 points than group KE （41 cases）. In addition,time to recovery and consciousness in group RE was considerably shorter than group KE （ P 〈 0.01 and P 〈 0.05, respectively）. Conclusion： The combination of remifentanil and etomidate can be safely applied as a pain-free approach in children who underwent gastrointestinal endoscopy as a result of more stable hemodynamic parameters, shorter time to consciousness and recovery in addition to minor adverse reactions during and after the examination as compared with the combination of ketamine and etomidate.