依托咪酯在内镜下食管静脉曲张治疗中麻醉效果

目的比较三种复合麻醉方法在胃镜下治疗食管静脉曲张患者时的镇静效果及其对呼吸循环影响。方法选择2011年6月—2012年12月在该院接受麻醉需要的胃镜下行食管静脉曲张治疗的患者90例,单盲随机分为3组,每组30例。I组先静注芬太尼,接着静注丙泊酚（1~2 mg/kg）;II组先静注芬太尼,接着静注依托咪酯（0.2~0.3 mg/kg）;Ⅲ组静注芬太尼,再静注丙泊酚＋依托咪酯混合液（剂量比7：1）。3组患者均给予2%利多卡因5 m L咽部表面麻醉,并给予芬太尼为0.5~1 ug/kg,总量不超过50 ug,待睫毛反射消失后开始进镜。观察术中镇静程度及记忆缺失、苏醒时间;注药前、置镜前、置镜后、苏醒后HR、MAP和脉搏血氧饱和度（Sp O2）的变化,术后恶心、呕吐。结果Ⅱ、Ⅲ两组注药前后及检查中血压变化,差异无统计学意义（P〉0.05）;I组注药后血压下降约15%~30%,与注药前血压比较,差异有统计学意义（P〈0.05）。3组置镜时100%无反应,3组100%术中无体动、呛咳,术后恶心呕吐Ⅱ组有5例（16%）,I组、Ⅲ组无。3组患者对检查过程无记忆。I组、Ⅲ组所有患者对此次检查治疗满意。Ⅱ组患者因恶心呕吐有10%患者不满意。结论咽部表面麻醉后采用芬太尼＋丙泊酚＋依托咪酯麻醉对胃镜下食管静脉曲张患者治疗安全、有效、简单易行。

The Anesthetic Effect of Etomidate in the Treatment of Esophageal Varices under the Endoscope

Objective To compare the sedative effects of three combined anesthesia methods in the treatment of esophageal varices under gastroscope and the impact of them on the respiration and circulation. Methods 90 patients undergoing the anesthesia for the treatment of esophageal varices under gastroscope were selected and divided into three groups single-blindly and randomly with 30 patients in each. Group I was first given intravenous injection of fentanyl, then propofol （1~2mg/kg）; Group II was first giv- en intravenous injection of fentanyl, then etomidate （0.2-0.3mg/kg）; Group III was first given intravenous injection of fentanyl, then intravenous injection of propofol and etomidate mixture （dose ratio 7：1）. Three groups of patients were given 2% lidocaine 5ml for pharyngeal surface anesthesia, and given fentanyl 0.5-1ug/kg, the total dose did not exceed 50ug, then started to put into the gas- troscope when the eyelash reflex disappeared. The intraoperative degree of sedation, amnesia and postanaesthetic recovery time, the HR, MAP and pulse oxygen saturation （SpO2） before injection of the drugs, before and after putting into the gastroscope and at the postanaesthetie recovery, and the postoperative nausea and vomiting of the patients were observed. Results There were no sta- tistically significant differences in the changes of blood pressure before and after injection of drugs and during the examination be- tween group II and group III （P〉0.05）. The blood pressure of group I dropped about 15%-30% after injection of drugs, compared with that before the injection, there was a statistically significant difference （P〈0.05）. 100% of the patients in the three groups had no response when the gastroscope was put into and no body movement and bucking during the operation. 5 cases （16%） in group Ⅱ while no patients in group I and group III had postoperative nausea and vomiting. All the patients in the three groups had no memory of the inspection process. All the patients in group I and grou