三种静脉全麻方法在高龄患者无痛胃镜检查中的应用及效果比较

摘要

目的：三种静脉全麻方法在高龄患者无痛胃镜检查中的应用及效果对比。方法选取我院2012年1月至2015年6月接收的210例高龄无痛胃镜检查患者作为研究对象，将其随机分为三组，每组70例。Ⅰ组：丙泊酚；Ⅱ组：丙泊酚+瑞芬太尼；Ⅲ组：依托咪酯+瑞芬太尼。比较三组患者用药前（T0）、检查中（T1）、睁眼后（T2）的MAP、HR、SPO2。统计三组术中及术后不良反应发生率，同时对三组术后苏醒时间及离院时间进行比较。结果 T1时点Ⅰ组、Ⅱ组MAP、SPO2相对于T0有明显下降，HR则有明显上升（P<0.01）；T2时点相对于T1时点MAP、HR、SPO2逐渐恢复。Ⅲ组各时点MAP、HR、SPO2水平比较均无统计学差异（P>0.05）；Ⅰ组、Ⅱ组患者术中SPO2<90%、术中心律失常、注射痛发生率明显高于Ⅲ组（P<0.01），三组术中体动、术中肌颤、恶心呕吐发生率比较则无统计学差异（P>0.05）；Ⅰ组与Ⅱ组的苏醒时间明显短于Ⅲ组（P<0.01），三组离院时间比较则无统计学差异（P>0.05）。三组麻醉费用比较无显著性差异（P>0.05）。结论依托咪酯+瑞芬太尼对循环、呼吸影响小，术中、术后不良反应发生率低，更适合于高龄无痛胃镜检查。%Objective To compare the effects of three kinds of general anesthesia in elderly patients re-ceiving painless gastroscopy. Methods From January 2012 to June 2015, 210 elderly patients receiving pain-less gastroscopy in Shifang City People′s Hospital were randomly divided into three groups with 70 cases in each group. GroupⅠ: propofol; groupⅡ: propofol+remifentanil; groupⅢ: etomidate+remifentanil. The mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SPO2) in T0, T1 and T2 were compared be-tween three groups. The incidence of adverse events, the recovery time, and the time to charge were compared between three groups. Results Compared with T0, MAP and SPO2 in groupⅠand groupⅡin T1 were sig-nificantly decreased, while HR was significantly increased. Compared with T1, SPO2, HR, and MAP in T2 be-gan to recover. There was no significant difference in MAP, SPO2, and HR in groupⅢamong T0, T1 and T2 (P>0.05). Compared with groupⅢ, the incidence rate of SPO2<90%, arrhythmia and injection pain during operation was significant higher in groupⅠand groupⅡ (P<0.01). The incidence rate of body movement, muscle vibration, nausea and vomiting was no significantly difference (P>0.05). The recovery time in groupⅠand groupⅡwas significantly shorter than that in groupⅢ(P<0.01). The time to charge was no signifi-cant difference between three groups (P>0.05). Conclusion Etomidate and remifentanil was more suitable for the elderly receiving painless gastroscopy because of few effects on circulatory and respiratory system and less adverse events in operation and postoperation.