异丙酚和依托咪酯复合瑞芬太尼对老年无痛胃镜患者的呼吸循环系统影响的比较

Comparison the cardiorespiratory system effects of propofol-remifentanil and etomidate-remifentanil sedation in older patients undergoing painless gastroscopy

目的对比观察异丙酚和依托咪酯复合瑞芬太尼对老年无痛胃镜患者呼吸循环系统的影响。方法选择该院内镜中心行无痛胃镜的400例老年患者,采用异丙酚和依托咪酯复合瑞芬太尼静脉麻醉,并分为异丙酚组(n=200)和依托咪酯组(n=200)。观察两组患者在诊断结果、胃镜置入时间、操作时间、苏醒时间、血流动力学、不良反应和满意度上的差别。结果两组患者在诊断结果上差异无统计学意义(P>0.05),在胃镜置入时间上依托咪酯组早于异丙酚组(P<0.05)。在血流动力学上,异丙酚组收缩压和舒张压在术中和术后明显低于依托咪酯组(均P<0.05);异丙酚组术后心率明显低于依托咪酯组(P<0.05);同时,异丙酚组术中SpO2也明显低于依托咪酯组(P<0.05)。异丙酚组总的不良反应发生率明显高于依托咪酯组(P<0.05);其中低氧血症和注射痛在异丙酚组明显高于依托咪酯组(均P<0.05);在体动和肌阵挛上,异丙酚组明显低于依托咪酯组(均P<0.05)。然而,在内镜医师和麻醉医师满意度上,异丙酚组明显高于依托咪酯组(均P<0.05)。结论在老年患者行无痛胃镜中,依托咪酯复合瑞芬太尼麻醉具有更稳定的血流动力学反应和较少的不良反应,值得在老年患者中推广。

Objective To compare the cardiorespiratory system effects of propofol-remifentanil and etomidate-remifentanil sedation in older patients undergoing diagnostic gastroscopy.Methods 400 older patients undergoing painless gastroscopy in endoscopy center of our hospital were chosen and randomly received intravenous propofol-remifentanil or etomidate-remifentanil sedation and divided into propofol group（n=200）and etomidate group（n=200）.The diagnosis,endoscopic insertion time,operation time,wake up time,hemodynamics,adverse reaction and satisfactory of patients in each group were observed.Results There were no difference between two groups in diagnosis（P〈0.05）;the onset time was earlier in the etomidate group（P〈0.05）.Systolic pressure and diastolic pressure in propofol group were lower than etomidate group during and after operation（all P〈0.05）;the heart rate in propofol group were lower than etomidate group after operation（P〈0.05）;meanwhile,the SpO2 in propofol group were lower than etomidate group during operation（P〈0.05）.All adverse events in propofol group were higher than etomidate group（P〈0.05）.Incidences of hyoxemia and injection pain were higher in the propofol group（all P〈0.05）,while those of body quiver and myoclonus were higher in the etomidate group（all P〈0.05）.However,Satisfaction of physician and anesthetist in the propofol group were better the etomidate group（all P〈0.05）.Conclusion Etomidate-remifentanil administration for sedation undergoing painless gastroscopy resulted in more stable haemodynamic responses and less adverse events in older patients.Etomidate-remifentanil administration was worth to be popularized in older patients.