布托啡诺与依托咪酯联合在老年病人肠镜检查中的应用

Clinical observation of butorphanol combined with etomidate used for painless enteroscopy in old patients

目的研究依托咪酯、布托啡诺静脉复合麻醉用于老年肠镜检查的可行性及安全性。方法随机将肠镜检查的老年患者120例分成3组:布托啡诺与依托咪酯联合组(BE组)40例、依托咪酯组(E组)40例、对照组(C组)40例。分析基础值、用药后、检查中及检查结束不同时点的血流动力学指标,观察治疗时间、清醒时间、依托咪酯的总用量及心律失常和恶心呕吐发生率。结果与用药前比较,E组、BE组在用药后检查前和检查中的SBP、DBP明显下降,HR减慢,差异均有统计学意义(t分别=-3.14、-2.01、-0.87,-3.11、-1.98、-0.89;-3.56、-1.98、-0.91,-2.93、-1.07、-1.01,P均<0.05),但均在30%范围内。C组在检查中的SBP、DBP与用药前比较,明显升高,HR、RR明显增快,差异均有统计学意义(t分别=-3.28、-2.05、-0.26、1.02、P均<0.05),而E组、BE组在检查中的SBP、DBP与C组比较,明显下降,HR、RR明显减慢,心律失常率降低,差异均有统计学意义(t分别=-2.04、-2.03、-0.33、1.04,χ2分别=5.17、5.59,P均<0.05)。BE组的依托咪酯总用量比E组少,差异有统计学意义(t=1.11,P<0.05)。结论布托啡诺与依托咪酯联合用于无痛肠镜检查对老年患者是一种安全有效的方法。

Objective To study the safety and feasibility of butorphanol and etomidate used for painless enteroseopy in old patients. Methods Patients undergoing enteroscopy were randomly allocated into 3 groups： etomidate group （group E, n=40）, butorphanol combined with etomidate group （group BE, n=40） and control group （group C, n=40）. Hemodynamic parameters at the point of basic value, after use of drugs, during enteroscopy and end of enteroscopy were analyzed. The enteroscopy duration, waking time, dose of etomidate, occurrence of arrhythmia, nausea and vomiting were recorded. Results Compared with the basic value, in group E and BE, SBP, DBP decreased and HR became slower after use of drugs and during enteroscopy, the differences were statistic significant （ t=-3.14,-2.01,-0.87, -3.11,-1.98,-0.89 ; -3.56,-1.98,-0.91, -2.93,-1.07,-1.01, P〈0.05 ）. In group C, SBP, DBP increased and HR, RR became faster during enteroscopy compared with those of the basic value, the differences were statistic significant （t=-3.28, -2.05, -0.26, 1.02, P〈0.05）. In group E and BE, SBP, DBP significantly decreased and HR, RR became slower significantly; the incidence of arrhythmia was significantly lower during enteroseopy compared with group C. The differences were statistic significant （t=-2.04, -2.03, -0.33, 1.04; x^2=5.17, 5.59, P〈 0.05）. The totally dose of etomidate in group BE was significantly lower than that of group E （t=1.11, P〈0.05）. Conclusions Butorphanol combined with etomidate is an effective and safe method painless enteroscopy in old patients.