丙泊酚联合依托咪酯用于无痛肠镜的安全性与可行性分析

Analysis of the safety and feasibility of propofol combined with etomidate for painless colonoscopy

目的探讨丙泊酚联合依托咪酯静脉注射用于无痛肠镜的安全性和可行性。方法前瞻性选取2018年12月至2019年5月在首都医科大学附属北京友谊医院消化内镜中心行择期诊断性无痛肠镜检查的606例患者作为研究对象,按照随机数字表法分成单用异丙酚组(P组,304例),异丙酚联合依托咪酯组(P+E组,302例)。收集并分析两组患者基线临床资料,比较两组患者麻醉诱导前(T0)、结肠镜进肛门(T1)、结肠镜过脾区(T2)、结肠镜进回盲部(T3)、结肠镜退出时(T4)、患者清醒时(T5)、患者离室前(T6)时的血压、心率、脉搏氧饱和度(SpO;)以及操作时间、恢复时间、麻醉及血管活性药等用量和不良事件等。结果两组患者基线数据无统计学差异(P> 0.05)。两组患者T0时收缩压、舒张压、平均动脉压、心率、SpO;差异无统计学意义(P> 0.05);诱导后两组患者血压、心率均有不同程度的下降,T1时P+E组的心率、舒张压、平均动脉压均明显高于P组,T2时P+E组的收缩压、舒张压、平均动脉压均明显高于P组,T3时P+E组的收缩压明显高于P组,差异均有统计学意义(P <0.05)。两组患者在不同时间点的SpO;差异均无统计学意义(P>0.05)。P+E组定向力恢复时间明显短于P组(71 s vs. 130 s),差异有统计学意义(P <0.05)。P+E组总体不良事件发生率、注射痛及体动发生率均明显低于P组(22.2%vs. 37.2%,4.0%vs. 11.8%,4.3%vs. 8.6%),差异均有统计学意义(P <0.05)。结论行无痛肠镜时,予以异丙酚联合依托咪酯镇静可明显改善血流动力学波动,减少术中总体不良事件、注射痛及体动的发生率。

Objective To explore the safety and feasibility of propofol combined with etomidate in patients undergoing diagnostic colonoscopy. Methods A total of 606 patients who underwent elective diagnostic painless colonoscopy in the Department of Gastroenterology and Digestive Endoscopy at Beijing Friendship Hospital Affiliated to Capital Medical University from December 2018 to May 2019 were prospectively selected as the research objects. All the patients were randomly divided into two groups: propofol group( P group,n = 304);propofol combined with etomidate group( P + E group,n = 302). Baseline data were recorded. Blood pressure,heart rate,pulse oxygen saturation( SpO;) at the time of baseline( T0),insertion of anus( T1),passing the splenic flexure( T2),passing the ileocecal junction( T3),extraction( T4),recovery( T5) and removal( T6) and operation time,induction time,recovery time,adverse events were monitored and collected. Results There was no statistical difference in baseline data between the two groups( P > 0. 05). There was no significant difference in systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,and SpO;at T0 between the two groups of patients( P > 0. 05);the blood pressure and heart rate of the two groups of patients decreased to varying degrees after induction. Heart rate,diastolic blood pressure,and average arterial pressure were significantly higher than those of group P. At T2,the systolic blood pressure,diastolic blood pressure,and average arterial pressure of P + E group were significantly higher than those of P group,at T3,the systolic blood pressure of P + E group was significantly higher than that of group P. In group P,the differences were statistically significant( P < 0. 05). There was no significant difference in SpO;between the two groups of patients at different time points( P > 0. 05). The recovery time in group P + E were significantly shorter compared with group P( 71 s vs. 130 s),the difference was statistically significant( P < 0. 05). The overall incidence of adverse events,injection pain and body movements in the P + E group were significantly lower than those in the P group( 22. 2% vs. 37. 2%,4. 0% vs. 11. 8%,4. 3% vs. 8. 6%),and the differences were statistically significant( P < 0. 05). Conclusion The combined use of propofol and etomidate could provide rapid return,improve hemodynamic stability and lessen overall side effects.