依托咪酯在老年患者无痛结肠镜检查中应用价值的随机对照研究

Randomized and Control Research of the Application Value of Etomidate in Elderly Patients with Painless Colonoscopy

目的:探讨依托咪酯在老年患者无痛结肠镜检查中的疗效及安全性。方法:选取2014年1月-2015年12月于笔者所在医院内镜室进行结肠镜检查的老年患者156例为研究对象,随机分为研究组和对照组,各78例。对照组采用静脉注射芬太尼后注射丙泊酚的麻醉方案,研究组采用静脉注射芬太尼后注射依托咪酯的方案。观察两者的麻醉效果,监测麻醉诱导前、诱导后1 min、进镜后4 min及9 min、出镜时、苏醒时患者的生命体征情况及不良反应等安全性评价。结果:对照组的起效时间与操作时间分别是(1.53±0.39)、(18.36±3.71)min,研究组分别是(1.49±0.41)、(17.57±4.13)min,两组麻醉起效时间和结肠镜操作时间比较差异均无统计学意义(P>0.05)。诱导后1 min、进镜后4 min及进镜后9 min,对照组平均动脉压(MAP)和血氧饱和度(Sp O2)均下降,心率(HR)减慢,与麻醉诱导前比较差异均有统计学意义(P<0.05);研究组MAP、Sp O2及HR变化与麻醉诱导前相比差异均无统计学意义(P>0.05);在相同观察点,对照组的MAP、Sp O2及HR均低于研究组,差异均有统计学意义(P<0.05)。研究组注射痛发生率为2.6%,低于对照组的48.7%,差异有统计学意义(P<0.05);在肌痉挛、恶心呕吐等方面两组差异无统计学意义(P>0.05)。结论:依托咪酯在老年患者无痛结肠镜检查中是安全有效的,对老年患者的循环和呼吸影响较小,注射痛较轻,是安全舒适的麻醉方案。

Objective： To investigate the efficacy and safety of Etomidate in elderly patients undergoing painless colonoscopy.Method： From January 2014 to December 2015 in our hospital 156 elderly patients undergoing painless colonoscopy were selected.They were randomly divided into research group applying the anesthesia scheme of Fentanyl combined with Etomidate and control group applying the anesthesia scheme of Fentanyl combined with Propofol.Heart rate（HR）, mean arterial pressure（MAP）, oxygen saturation（SpO2） and adverse reactions were observed between the two groups at：the point of before anesthesia induction, one minute after induction, four minutes and nine minutes after into the mirror, checking end, waking up.Result： The onset time and operation time of the control group were （1.53 ± 0.39）minutes and （18.36 ± 3.71）minutes, while these of the research group were respectively （1.49 ± 0.41）minutes and （17.57 ± 4.13）minutes. There were not statistically different between the two groups（P〉0.05）.Compared with the time of before anesthesia induction, there were statistically significant differences in the HR, MAP and SpO2 of the control group at the points of one minute after induction, four minutes and nine minutes after into the mirror（P〈0.05）. There were no statistically significant differences in the HR, MAP and SpO2 of the research group compared with the time of before anesthesia induction（P〉0.05）. At the same point, there were statistically significant differences between the two groups in the HR, MAP and SpO2（P〈0.05）.The injection pain incidence of the research group was 2.6%, lower than 48.7% of the control group, the difference was statistically significant（P〈0.05）.There were not statistically significant difference in the muscle cramps, nausea, vomiting（P〉0.05）.Conclusion： Etomidate is safe and effective in elderly patients with painless colonoscopy.It can provide fewer stimulation of circulation＇and respiration and less pain on injection of elderly patients.It is a safe and comfortable solution.