戊乙奎醚与依托咪酯用于无痛胃镜诊疗的对照研究

目的观察戊乙奎醚与依托咪酯在无痛胃镜诊疗中应用的利弊。方法选择美国麻醉师协会(ASA)Ⅰ～Ⅱ级,于我院行无痛胃镜检查或治疗的患者100例,随机分为2组,A组(常规组)48例,诱导用药:阿扎司琼0.2mg/kg、芬太尼1μg/kg、丙泊酚2mg/kg,序贯静脉注射;维持用药:间断给予丙泊酚;B组(依托咪酯组)52例,诱导用药:戊乙奎醚0.01mg/kg、阿扎司琼0.2mg/kg、芬太尼1μg/kg、依托咪酯0.15mg/kg、丙泊酚1mg/kg,序贯静脉注射;维持用药:间断给予丙泊酚、依托咪酯。比较2组的诱导时间、血流动力学指标(意识消失时、胃镜插入后即刻、胃镜拔出后即刻的血压、心率)、呼吸抑制的发生率、苏醒时间及术后并发症的发生率。结果 2组诱导时间差异无统计学意义,A组呼吸抑制发生率高于B组(P<0.05),苏醒时间明显短于B组(P<0.05),B组术后并发症的发生率明显高于A组(P<0.05),且复视多见于青年人,谵妄多见于老年人。A组麻醉后各时点的血压、心率明显低于麻醉前及同时点B组水平(P<0.05),A组意识消失时的血压低于胃镜拔除后即刻(P<0.05);B组麻醉后各时点的血压、心率稍降低,但与麻醉前相比差异无统计学意义(P>0.05)。结论在无痛胃镜诊疗中推荐应用依托咪酯,尽量避免应用戊乙奎醚。

A contrast study of penehyclidine hydrochloride and etomidate used in sedative gastroscope

Objective To investigate the advantage and disadvantage of penehyclidine hydrochloride and etomidate used in sedative gastroscope.Methods One hundred cases who were ASA Ⅰ～Ⅱ,examined or cured by sedative gastroscope,were chosen and randomly divided into two groups.Group A(regular anesthesia group): 48cases,anesthesia induction:azasetron 0.2mg/kg,fentanyl 1μg/kg,propofol 2mg/kg,injected sequentially by vein.Group B(etomidate group):52cases,anesthesia induction:penehyclidine hydrochloride 0.01mg/kg,azasetron 0.2mg/kg,fentanyl 1μg/kg,etomidate 0.15mg/kg,propofol 1mg/kg,injected sequentially by vein.Induction time,haemodynamics(the time point of unconsciousness,putting the endoscopy into esophagus,pulling the endoscopy out of patient),the rate of breath-holding,recovery time and the rate of postoperative complications were compared.Results There was no difference in the induction time(P>0.05),the rate of breath-holding of A group was higher than that of B group(P<0.05),the recovery time was shorter than that of B group(P< 0.05),the postoperative complications of B group were more than that of A group(P<0.05),and diplopia was seen more common in young people,delirium was seen more at old people.The blood pressure and heart rate after the anesthesia of A group were significantly lower than the level before anesthesia and the same time point of group B(P<0.05),the blood pressure of unconsciousness was lower than the level of pulling the endoscopy out patient in A group(P<0.05).The blood pressure and heart rate after anesthesia were slightly lower than the level before anesthesia,but there is no statistical difference in B group(P>0.05).Conclusion It is suggested etomidate be used in sedative gastroscop.And application of penehyclidine hydrochloride should be avoided.