靶控输注依托咪酯或异丙酚在老年患者胃镜检查中的应用

Application of etomidate or propofol given by target controlled infusion in aged gastroscopy sedation

目的比较靶控输注依托咪酯或异丙酚麻醉在老年患者胃镜检查中的安全性、有效性和优越性。方法患者静脉注射芬太尼0.05μg/kg,1min后随机分为两组(n=30):E组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组静脉靶控输注异丙酚,设定效应室浓度为3μg/mL(Marsh模型)。于给药前(T0),插镜时(T1),过食道入口时(T2)、贲门(T3)、十二指肠球部(T4)各时点分别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。结果两组的胃镜检查时间、麻醉恢复时间、镇静镇痛评分、不良反应及满意度差异都无显著性(P>0.05)。E组患者术中血流动力学无显著性变化(P>0.05);P组患者术中MAP持续下降,T1、T2、T3及T4时刻分别较给药前显著下降(P<0.05)。结论在老年患者胃镜检查麻醉中,靶控输注依托咪酯或异丙酚同样安全有效。但靶控输注依托咪酯对血流动力学的影响更轻微,优于异丙酚,在老年患者中有一定优越性。

[Objective] To investigate the analgesic efficacy and safety of etomidate or propofol given by target controlled Infusion （TCI） in gastroscopy sedation. [Methods] 60 outpatients scheduled to undergo gastroscopy were randomly divided into 2 groups （n=30）： Patients in group E received fentanyl （0.05 μg/kg） then etomidate given by TCI targeting effect-site （0.3 μg/mL）; Patients in group P received fentanyl （0.05 μg/kg） then propofol given by TCI targeting effect-site （3 μg/mL）. The HR, ECG, SPO2, MAP in both groups were continuously monitored during the study. Pain grades, operation, adverse reaction and patients satisfaction were recorded. [Results] Pain grades, operation time, adverse reaction and patients satisfaction were not significantly different between two groups （P 0.05）. The MAP value of group P patients were significantly decreased during operation （P 0.05）. [Conclusion] Etomidate and propofol given by target controlled infusion can provide adequate sedation and analgesia in gastroscopy,and etomidate given by TCI may be more suitable for aged gastroscopy sedation in regard to hemodynamics.