依托咪酯不同靶控质量浓度输注复合芬太尼用于无痛胃肠镜检查术的麻醉效果比较

Comparison of Anesthetic Efficacy of Different Target-Controlled Concentrations of Etomidate in Combination with Fentanyl in Painless Gastrointestinal Endoscopy

目的比较依托咪酯不同靶控质量浓度输注复合芬太尼用于无痛胃肠镜检查术的麻醉效果。方法择期行无痛胃肠镜检查男性患者60例,年龄为30~70岁,ASA分级Ⅰ—Ⅱ级,体质量45~75kg,随机分为A、B、C 3组,分别对应依托咪酯效应室靶控质量浓度0.6、0.8及1.0μg·mL-1,内镜检查前单次静脉注射芬太尼（1μg·kg-1）后靶控输注依托咪酯行静脉麻醉,靶控输注泵显示效应室控质量浓度达到目标质量浓度时开始检查,检查结束时停止靶控输注。记录在麻醉诱导前（T0）、进胃镜检查时（T1）、进结肠镜检查时（T2）、检查结束时（T3）、患者清醒时（T4）的血压（SBP/DBP）、心率（HR）及脉搏氧饱和度（SpO2）,记录依托咪酯的用量、SpO2最低值、患者苏醒时间,记录肌阵挛发生率、需麻黄碱、阿托品静脉注射以及出现呼吸暂停、体动、呛咳的患者例数。结果组内比较：与T0比较,A组在T1—T2时点,SBP、DBP和HR显著升高（P〈0.05）;B组在各时点差异无统计学意义（P〉0.05）;C组T1—T3时点,SBP、DBP、HR以及SpO2降低（P〈0.05）。组间比较：与B组比较,A组依托咪酯的用量减少及体动、呛咳的患者例数增多（P〈0.05）,C组依托咪酯的用量、呼吸暂停例数及需麻黄碱、阿托品静注的患者例数增多（P〈0.05）。3组患者苏醒时间、肌阵挛发生率差异无统计学意义（P〉0.05）。结论依托咪酯靶控输注复合芬太尼应用于无痛胃肠镜检查术的最适宜的靶控效应室质量浓度为0.8μg·mL-1。

Objective To compare the anesthetic efficacy of different target-controlled concentrations of etomidate in combination with fentanyl in painless gastrointestinal endoscopy.Methods According to the target effect-site concentrations of etomidate,60 male patients scheduled for elective painless gastrointestinal endoscopy（ASA Ⅰ-Ⅱ,30-70 years of age,body weight 45-75kg）were randomized into three groups：0.6μg·mL-1（group A）,0.8μg·mL-1（group B）and 1.0μg·mL-1（group C）.Target-controlled infusion of etomidate was performed after intravenous fentanyl injection（1μg·kg-1）to induce intravenous anesthesia.Gastrointestinal endoscopy was performed when the effect-site concentrations of etomidate reached the target concentrations.Targetcontrolled infusion of etomidate was stopped at the end of gastrointestinal endoscopy.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）and blood oxygen saturation（SpO2）were measured before the induction of anesthesia（T0）,at the beginning of gastroscopy（T1）,at the beginning of colonoscopy（T2）,at the end of gastrointestinal endoscopy（T3）,and in waking state（T4）.In addition,the dosage of etomidate,minimum SpO2,recovery time,incidence of myoclonus,and number of patients who required ephedrine or atropine injection or had apnea,body movement or cough were recorded in all the three groups.Results Compared with T0,SBP,DBP and HR increased at T1-T2 in group A,as well as at T1-T3 in group C（P〈0.05）.There were no significant differences in SBP,DBP and HR among different time points in group B（P〉0.05）.Compared with group B,the dosage of etomidate decreased and the number of patients with body movement or cough increased in group A（P〈0.05）.However,the dosage of etomidate and number of patients who had apnea or required ephedrine or atropine injection increased in group C,compared with group B（P〈0.05）.There were no significant differences in recovery time and incidence of myoclonus among the three groups（P〉0.05）.Conclusion The optimum target-controlled concentration of etomidate is 0.8μg·mL-1 when combining fentanyl in painless gastrointestinal endoscopy.