不同剂量的依托咪酯-丙泊酚在老年高血压患者无痛胃镜中的应用观察

Application of Different Doses of Etomidate-propofol in Painless Gastroscopy of the Elderly with Hypertension

目的比较不同剂量丙泊酚依托咪酯用于老年高血压患者无痛胃镜麻醉的效果及安全性。方法150例行无痛胃镜检查的老年高血压患者随机分为3组,每组50例,A组顺次予以丙泊酚1mg/kg,依托咪酯0.2mg/kg;B组给予丙泊酚1.5mg/kg,依托咪酯0.1mg/kg;C组给予丙泊酚2mg/kg。记录给药前(T0)、意识消失(T1)、胃镜过咽喉口(T2)、手术结束(T3)、意识恢复(T4)时的平均动脉压(MAP)、心率(HR)和脑电双频指数值(bispectralin-dex,BIS)。记录术中最低BIS值及意识恢复和定向力恢复时间。统计术中注射痛、肌阵挛、术中体动、过度抑制.(BIS<40持续30s)、严重低血压(较术前血压降低≥40%)、严重心动过缓(HR<52bpm)、苏醒延迟等不良反应的例数。结果各组T1-T4时刻MAP及BIS值较T0时刻明显下降,以C组下降幅度最为显著(P<0.05);各组T1、T3、T4时刻点HR较T0下降,但T2时刻点A、B两组表现为HR增快,而C组较T0时刻HR减缓,差异均具有统计学意义(P<0.05);同时刻点各组间比较,T2-T4时刻,A组和B组MAP、HR值均高于C组,T2-T3时A组MAP高于B组,T3时A组HR高于B组,T2-T4各时刻点BIS值A组>B组>C组,差异有统计学意义(P<0.05);术中A、B组最低BIS值均高于C组(P<0.05);A组意识和定向力恢复比C组迅速(P<0.05);围术期BIS过度抑制、严重.低血压、严重心动过缓等并发症的发生例数A组<B组<C组,C组苏醒延迟的例数高于A、B两组(P<0.05)。结论采用丙泊酚1mg/kg+依托咪酯0.2mg/kg实施老年高血压患者无痛胃镜麻醉,血流动力学平稳,镇静深度适宜,麻醉复苏快,安全性更高。

Objective To compare the efficacy and safety of different doses of propofol-etomidate applied in painless gastroscopy anesthesia of the elderly with hypertension.Methods 150 elderly with hypertension undergoing painless gastroscopy were randomly divided into 3 groups:group A,group B and group C,50 in each;intravenous injection was performed on the elderly in the 3 groups(propofol lmg/kg and etomidate 0.2 mg/kg in group A,propofol 1.5 mg/kg and etomidate 0.1 mg/kg in group B and propofol 2 mg/kg in group C);the mean arterial pressure(MAP),heart rate(HR) and bispectral index(BIS) values at the time point of pre-administration(T0);loss of consciousness(T1),gastroscope through the throat(T2),end of surgery(T3) and recovery of consciousness(T4) were recorded as well as the lowest BIS value during operation,the time of consciousness recovery and orientation recovery;intraoperative injection pain,myoclonus,intraoperative body movement,excessive suppression(BIS <40 for 30 s),severe hypotension(≥40% lower than preoperative blood pressure);severe bradycardia(HR <52 bpm) and the number of cases with adverse reactions such as postponed wakening were statistically studied;Results The MAP and BIS of the elderly in each group decreased obviously from T1 to T4 and the decrease in group C was the biggest;the HR of the elderly in each group at T1,T3 and T4 were lower than that at T0,the HR in group A and group B at T2 were higher while that in group C was lower than those at T0;the MAP and HR in group A and group B at T2,T3 and T4 were higher than those in group C;the MAP in group A at T2 and T3 was higher than that in group B and the HR in group A at T3 was higher than that in group B;the BIS values in the 3 groups at the time point from T2 to T4 were ranged as group A>group B>group C,the difference was of statistical significance(P<0.05);the lowest BIS value in group A and in group B was both higher than that in group C(P<0.05);the recovery of consciousness and orientation in group A was faster than that in group C(P<0.05);the case number of adverse reactions including perioperative BIS over suporession,severe hypotension and severe bradycardia in the 3 groups were ranged group A<group B<group C while the case number of postponed wakening was bigger than that in group A and that in group B(P<0.05).Conclusions The dosage regimen of propofol lmg/kg combined with etomidate 0.2 mg/kg for painless gastroscopy anesthesia of the elderly with hypertension can lead to more stable hemodynamics,more suitable depth of sedation and faster anaesthesia anabiosis with higher safety.