依托咪酯联合舒芬太尼用于老年眼内手术的临床研究

Combination of Etomidate and Sufentanil for Elderly Intraocular Surgery

目的:探讨依托咪酯和舒芬太尼联合应用于老年眼内手术的可行性和安全性。方法:对48例年龄>60岁的白内障、青光眼手术患者随机分为观察组和对照组,各24例。观察组术前缓慢注射舒芬太尼0.1μg/kg,同时靶控输注依托咪酯,调整效应室靶控浓度,使镇静评分达3级;对照组不作处理。观察两组不同时间点SBP、DBP、HR、SPO2、BIS、心电图ST段、镇静程度的变化及恶心呕吐、舌后坠的发生率,评价球后神经阻滞时VAS、患者满意度、医生满意度。结果:两组患者各时间点SBP、DBP、HR、心电图ST段比较差异无统计学意义(P>0.05),恶心呕吐、舌后坠的发生率差异无统计学意义(P>0.05),SPO2有不同程度升高(P<0.05);观察组用药后BIS明显下降、镇静程度升高,差异均有统计学意义(P<0.05);神经阻滞时VAS评分与对照组比较明显降低(P<0.01);对照组球后神经阻滞后BIS值与基础值比较明显下降、镇静程度也升高,差异有统计学意义(P<0.01);观察组患者满意度、医生满意度均高于对照组(P<0.01)。结论:依托咪酯和舒芬太尼联合应用于老年眼内手术,可降低神经阻滞时疼痛程度,提高患者和医生满意度,安全性良好。

Objective： To study the feasibility and safety of the combination of etomidate and sufentanil for elderly intraocular surgery.Methods： A total of 48 patients undergoing cataracts or glaucoma surgery,age 60 years old above,were randomly divided into trial group and control group.In the trial group,sufentanil of 0.1 μg/kg was slowly injected and etomidate was used with target control infusion,reaching sedation score of grade 3.The control group did not process for analgesia and sedation.SBP and DBP,HR,SPO2,BIS,electrocardiogram section,and sedation degree at different time points,and the incidence of nausea and vomiting and glossoptosis were observed.Visual analogue scale（VAS） at nerve blocking,patient satisfaction,and doctors satisfaction were evaluated.Results： SBP and DBP,HR,and electrocardiogram section of the 2 groups at each time point were stable（P〉0.05）;the incidence of nausea and vomiting and glossoptosis did not differ between the 2 groups（P〉0.05）;and SPO2 increased compared to baseline（P〉0.05） in both groups but with no difference between them（P0.05）.BIS dramatically declined and sedation degree increased（P〈0.01）after use of drugs in the trial group,and the VAS at nerve blocking was significantly lower than that of the control group（P〈0.01）.BIS of the control group markedly decreased after nerve block and sedation degree increased（P〈0.01）.Both patients＇ and surgeons＇ satisfaction of the trial group were higher than those of the control group（P〈0.01）.Conclusion： The combination of etomidate and sufentanil applied in elderly intraocular surgery can safely and easily reduce the pain degree at nerve blocking,enhancing both patients＇ and surgeons satisfaction.