目的 探讨靶控输注依托咪酯或异丙酚在肠镜检查中应用的安全性、有效性和对血流动力学的影响,寻找一种更适合肠镜检查的麻醉方式.方法 患者随机分为3组(n=30):E组患者静脉注射芬太尼1μg/kg,1 min后静脉靶控输注依托咪酯,设定效应室浓度为0.3μg/mL(Arden模型);P组患者静脉注射芬太尼1μg/kg,1 min后静脉靶控输注异丙酚,设定效应室浓度为3μg/mL(Marsh模型);C组为对照组(未进行麻醉).观察并记录患者术中血流动力学变化以及SPO2变化、镇静及镇痛评分、不良反应及满意度评估.结果 与C组相比,E组和P组的内镜操作时间均明显缩短(P＜0.05),疼痛评分均明显降低(P＜0.05).E组和P组的内镜操作时间、恢复时间、镇静评分、不良反应及满意度差异均无显著性(P＞0.05).E组患者术中血流动 力学无显著变化(P＞0.05);P组患者术中MAP持续下降,T3、T4时刻分别较给药前显著下降(P＜0.05);C组患者术中T3、T4时刻MAP和HR较给药前显著升高(p＜0.05).E、P组患者术后满意度显著高于C组(P＜0.05).结论 靶控输注依托咪酯或异丙酚均可安全应用于肠镜检查麻醉,且靶控输注依托咪酯对血流动力学的影响更轻微,更适于肠镜检查患者.%[Objective] To investigate the analgesic efficacy and safety of etomidate or propofol given by target controlled Infusion (TCI) in colonoscopy sedation. [Methods] 90 outpatients scheduled to undergo colonoscopy were randomly divided into three groups (n =30): Patients in group E received fentanyl (1 μg/kg) then etomidate given by TCI targeting effect-site (0.3 μg/mL); Patients in group P received fentanyl (1 Jig/kg) then propofol given by TCI targeting effect-site (3 μg/mL); No preventive measure were taken in the control group. The HR, ECG, SpCs, MAP in three groups were continuously monitored during the study. Pain grades, time to reach cecum,adverse reaction and patients satisfaction were recorded. [ Results ] The pain score of patients in group E and P were significantly lower than those in group C (P <0.05). The time to reach cecum was shorter in group E and P than in group C (P <0.05). The MAP value of group P patients was significantly decreased during operation (P <0.05). Patients satisfaction was better in group E and P than in group C (P <0.05). [Conclusion] Etomidate and propofol given by target controlled infusion can provide adequate sedation and analgesia in colonoscopy, and etomidate given by TCI may be more suitable for colonoscopy sedation in regard to hemodynamics.
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