无痛胃镜检查中应用依托咪酯及戊乙奎醚的临床观察

Clinical study on penehyclidine hydrochloride and etomidate in sedative gastroscope examination

目的观察依托咪酯和戊乙奎醚在无痛胃镜检查中应用的优缺点。方法选择2012-06~2012-09于中南大学湘雅医学院附属海口医院行无痛胃镜检查的患者98例,ASAⅠ-Ⅱ级,随机分为3组。A组(戊乙奎醚组):36例,诱导之前先给戊乙奎醚0.01 mg/kg,后序贯静脉给予昂丹司琼0.1 mg/kg、芬太尼1μg/kg、依托咪酯0.15 mg/kg、丙泊酚1 mg/kg;麻醉维持以丙泊酚、依托咪酯交替给药。B组(依托咪酯组):30例,除不用戊乙奎醚外,余处理同A组。C组(对照组):32例,诱导用药:昂丹司琼0.1 mg/kg、芬太尼1μg/kg、丙泊酚2 mg/kg,序贯静脉注射;维持用药:间断给予丙泊酚。比较三组的诱导时间、苏醒时间、呼吸抑制发生率、血流动力学指标(意识消失时、胃镜插入后即刻、胃镜拔出后即刻的血压、心率)及术后并发症的发生率。结果三组的诱导时间差异无统计学意义,A、B组呼吸抑制发生率明显低于C组(P<0.05),苏醒时间明显长于C组(P<0.05),A组术后并发症的发生率明显高于B、C组(P<0.05),且复视多见于青年人,谵妄多见于老年人。A、B组麻醉后各时点的血压、心率稍降低,但与麻醉前相比差异无统计学意义(P>0.05)。C组麻醉后各时点的血压、心率明显低于麻醉前及同时点A、B组水平(P<0.05)。结论在无痛胃镜检查中推荐应用依托咪酯,尽量避免应用戊乙奎醚。

Objective To investigate the advantages and disadvantages of penehyclidine hydrochloride and etomidate in sedative gas- troscope examination. Methods Totally 98 ASA I - II patients examined by sedative gastroscope were randomly divided into three groups ： penehyclidine group （ group A, n = 36）, etomidate group （ group B, n = 30） and control group （ group C, n = 32）. The patients in group B were sequentially injected with ondansetron 0. 1 mg/kg, fentanyl 1 μg/kg, etomidate 0.15 mg/kg and propofol 1 mg/kg via vein, and then propofol and etomidate were injected alternately to maintain the anesthesia. Based on this, the patients in group A were additionally injected with penehyclidine 0.01 mg/kg before anesthesia induction. The patients in control group were sequentially injected with ondansetron 0.1 mg/kg, fentanyl 1 p^g/kg and propofol 2 mg/kg to induce the anesthesia, and then intermittently injected with propofol to maintain the anesthesia. Induction time, recovery time, the rate of breath-holding, haemodynamic indicators（ blood pres- sure, heart rate）at the unconsciousness, putting the endoscopy into esophagus and pulling the endoscopy out, and the incidences of post- operative complications were compared among three groups. Results There was no difference in the induction time among three groups （ P 〉 0.05 ）. The rates of breath-holding in group A and group B were lower than that in group C （ P 〈 0.05 ）, the recovery time in group A and group B was longer than that in group C （P 〈 0.05 ）, and the incidence of postoperative complications in group A was higher than those in group B and group C （ P 〈 0.05 ）. Diplopia was seen more common in young patients, and delirium was found more in old patients. The blood pressure and heart rate after anesthesia were slightly lower than the level before anesthesia in group A and group B, but there was no significant difference （ P 〉 0.05 ）. The blood pressure and heart rate after the anesthesia in group C were sig- nificantly lower than the level before anesthesia and those at the same time point in group A and group B （P 〈 0. 05）. Conclusion Etomidate should be recommended to use in sedative gastroscope examination, but not penehyclidine hydrochloride.