依托咪酯-丙泊酚镇静在门诊结肠镜检查中的应用

摘要

目的：比较单独或联合使用依托咪酯和丙泊酚的不同镇静方案在无痛结肠镜检查中的安全性和不良反应。方法选择拟行无痛结肠镜检查患者280例,男128例,女152例,年龄18~65岁,体重45~70 kg,ASAⅠ~Ⅲ级,随机分为四组,每组70例。P 组采用丙泊酚1 mg/kg 诱导后,每次给予丙泊酚0.5 mg/kg 维持；EP 组采用依托咪酯0.2 mg/kg 诱导后每次给予丙泊酚0.5 mg/kg维持；PE 组采用丙泊酚1 mg/kg 诱导后每次给予依托咪酯0.1 mg/kg 维持；E 组采用依托咪酯0.2 mg/kg 诱导后每次给予依托咪酯0.1 mg/kg 维持。记录四组患者镇静前后的 MAP、HR、SpO 2；记录患者诱导和恢复时间以及不良反应发生情况。结果 EP 组(16.7±10.1)mm Hg和 E组(14.5±8.7)mm Hg的ΔMAP 的下降值明显小于 P 组(26.2±10.1)mm Hg和 PE 组(24.4±9.4)mm Hg(P <0.05)。EP 组(61.3±19.5)s 和 E 组(60.1±20.3)s 的诱导时间明显短于 P 组(70.3±25.9)s 和 PE 组(72.2±29.8)s(P <0.05)。EP 组(11.42%)和 E 组(1.85%)的低血压发生率明显低于 P 组(51.42%)和 PE 组(37.14%)(P <0.05)。E 组(4.28%)上呼吸道梗阻发生率明显低于其它三组(P <0.05)。E 组肌颤发生率(41.42%)明显高于其它三组,EP 组肌颤发生率(20%)明显高于 P 组(0%)和 PE 组(5.71%)(P <0.05)。只有 E 组发生术后恶心呕吐。结论依托咪酯诱导、丙泊酚维持镇静对血流动力学影响较小,能快速诱导；与单独应用依托咪酯比较,肌颤、恶心呕吐的发生率更低。%Objective This prospective study aimed to compare the safety and side effects of the single or combined application of etomidate and propofol sedation regimens for patients under elec-tive colonoscopy.Methods Two hundred and eighty patients scheduled for colonoscopy(128 males and 1 52 females,aged 18 to 65 years,weight 45-70 kg,ASA Ⅰ-Ⅲ grade),were randomized into four groups (n = 70 each):group P (propofol 1 mg/kg for induction and 0.5 mg/kg for mainte-nance),group EP (etomidate 0.2 mg/kg for induction and propofol 0.5 mg/kg for maintenance), group PE (propofol 1 mg/kg for induction and etomidate 0.1 mg/kg for maintenance)and group E (etomidate 0.2 mg/kg for induction and etomidate 0.1 mg/kg for maintenance).MAP,HR,SpO 2 , side effects and the induction and recovery time.Results The decreased value of MAP (ΔMAP)in group EP (1 6.7±10.1)mm Hg and group E (14.5 ±8.7)mm Hg was less than those of group P (26.2±10.1)mm Hg and group PE (24.4±9.4)mm Hg (P <0.05).Group EP (61.3 ± 1 9.5 )s and group E (60.1±20.3)s had a shorter induction time than group P (70.3±25.9)s and group PE (72.2±29.8)s (P <0.05).The incidence of hypotension in group EP (1 1.42%)and E (1.85%) were lower than in the group P (5 1.42%)and group PE (37.14%)(P < 0.05).The incidence of upper airway obstruction in group E (4.28%)was lower than the other three groups significantly (P< 0.05).The incidence of myoclonus in group E (41.42%)was highest,and that in group EP (20%)was higher than group P (0%)and PE (5.71%)(P <0.05).Patients in group E had postop-erative nausea and vomiting.Conclusion Compared with propofol-induce and etomidate alone,seda-tion using etomidate-propofol during colonoscopy has slight influence on haemodynamics,shorter in-duce time,less incidence of myoclonus and postoperative nausea and vomiting.