依托咪酯复合咪达唑仑及芬太尼麻醉在无痛胃肠镜联合检查中的应用

目的探讨依托咪酯复合咪达唑仑及芬太尼麻醉在无痛胃镜和肠镜联合检查中应用的麻醉效果和安全性。方法120例无痛胃镜和结肠镜联合检查的患者，按抽签法随机分为依托咪酯复合组（E组，n=60）和丙泊酚复合组（P组，n=60）。依次静脉注射咪达唑仑1．0～1．5mg，芬太尼0．05～0．07mg，丙泊酚1．0—1．5mg／kg或依托咪酯0．1～0．3mg／kg，待患者入睡，睫毛反射消失后开始胃镜检查，最后行结肠镜检查，检查中酌情追加小剂量依托咪酯或丙泊酚。记录两组患者镜检前、镜检即刻，置入镜后3、5、8、10和15min的SBP、DBP、HR、Sp02变化、苏醒时间和不良反应。结果全部病例麻醉均满意，均顺利完成检查或治疗；苏醒时间E组（7．1±3．6）min，P组（6．8±3．2）min，E组苏醒时间比P组稍长，但两组比较差异无统计学意义（P〉0．05）。所有患者麻醉后血压和心率均有不同程度下降，其中血压下降超过基础血压的20％或〈90mmHg，P组16例（26．7％），E组3例（5％），两组比较有统计学差异（P〈0．01）；患者心率低于55次（／min，P组有11例（18．3％），E组有2例（3．3％），两组比较有统计学差异（P〈0．05）。SpO2一过性低于90％，P组13例（21．7％），E组1例（1．7％），两组比较差异有统计学意义（P〈0．01）。结论依托咪酯或丙泊酚复合咪达唑仑及芬太尼麻醉在无痛胃肠镜联合检查中的麻醉效果均满意，但依托咪酯复合咪达唑仑及芬太尼麻醉可维持较为稳定的血流动力学，对呼吸和循环的影响更小，更适合老年患者无痛胃肠镜联合检查术。

Application of Etomidate combined with Midazolam and Fentanyl to anesthesia in joint painless gastroscopy and colonoscopy

Objective To investigate the anesthetic effect of Etomidate combined with Midazolam and Fentanyl on joint examination of painless gastroscopy and colonoscopy. Methods A total of 120 patients undergoing painless gastroscopy and colonoscopy were randomly divided into two groups, i.e. Etomidate composite group （ E group, n = 60） and Propofol composite group （ P group, n = 60）. In both the groups, patients were given Midazolam 1.0 - 1.5 mg and Fentanyl 0.05 - 0.07 mg intravenously. Subsequently, P group patients were given Propofol 1.0 - 1.5 mg/kg intravenously while E group ones were given Etomidate 0.1 - 0.3 mg/kg in- travenously. After the patient fell asleep and the lash reflex was abolished, we sequentially started the gastroscopy and colonoscopy. During the examination process, small dose of Etomidate or Propofol was added as appropriate. We recorded awakening time, ad- verse re~actions and changes in patient＇ s systolic blood pressure （SBP） , diastolic blood pressure （DBP） , heart rate （HR） and SpO2 at the following time points： before endoscopy, endoscopy instantly, and 3 - , 5 - , 8 - , 10 -and 15 -min after the inser- tion of endoscopy. Results The anesthetic effects of both the two groups were satisfactory and the examination was successfully completed. The patient＇s awakening time in E group was （7. 1± 3.6 ） min, without statistically significant difference from that （6.8 ± 3.2） min ] in P group （ P,〉 0.05 ）. Blood pressure and HR were decreased in all the patients after anesthesia. In p group, there were 16 （26.7%） patients v（hose blood pressures were decreased by more than 20% over basal blood pressure or low- er than 90 mmHg after anesthesia; while in E group the fluctuation happened only in 3 （5%） patients. The difference was statisti- cally significant （P 〈0.01 ）. There were 11 ,（ 18.3% ） patients in P group with low HR less than 55 beats per minute after anes- thesia, whereas in E group there were only 2 （3.3%） ones with low HR （P 〈0.05）. As for SpO2 lower than 90%, the coun- terparts were 13 （ 21.7 % ） vs. 1 （ 1.7 % ） , between which the difference was statistically significant （P 〈 0.01 ）. Conclusion Ei- ther Etomidate or Propofol, in combination with Midazolam and fentanyl, is clinically satisfactory and safe in the anesthesia of joint pain- less gastroscopy and colonoscopy. However, in comparison, Etomidate has smaller impact on respiratory and circulatory function, and therefore is more suitable for elderly patients.