右美托咪定联合舒芬太尼对老年无痛胃镜检查患者依托咪酯所致肌颤的影响

Effect of dexmedetomidine combined with sufentanil on etomidate induced myofasmia in elderly patients undergoing painless gastroscopy

目的 探讨右美托咪定联合舒芬太尼对老年无痛胃镜检查患者依托咪酯所致肌颤的影响。方法 选取老年无痛胃镜检查患者90例,随机分为A组和B组,各45例。A组胃镜检查前缓慢静注舒芬太尼0.1μg/kg,2~3 min后缓慢静注依托咪酯0.2 mg/kg。B组胃镜检查前通过静脉泵将右美托咪定6~8μg注入静脉通道内,然后缓慢静注舒芬太尼0.1μg/kg,2~3 min后缓慢静注依托咪酯0.2 mg/kg。比较两组镇静持续时间、检查时间、苏醒时间、离院时间、追加依托咪酯比例、围术期生命体征变化、检查前后应激反应、肌颤和不良事件发生率。结果 两组镇静持续时间、检查时间、苏醒时间、离院时间比较,差异无统计学意义(P均>0.05)。B组追加依托咪酯比例低于A组(P<0.05)。与麻醉前比较,两组置镜时、镜体至会厌时、检查结束时心率、呼吸频率、平均动脉压均有不同程度的波动,但B组较A组更稳定(P均<0.05)。两组胃镜检查后血清C反应蛋白、皮质醇、去甲肾上腺素水平较检查前升高(P均<0.05),但B组检查后水平低于A组(P均<0.05)。B组肌颤发生率低于A组(P<0.05)。A组术中呛咳、术中躁动的发生率均高于B组(P均<0.05)。结论 右美托咪定联合舒芬太尼用于老年无痛胃镜检查患者,可减少依托咪酯所致肌颤的发生,且不良事件的发生率较低,有一定临床推广价值。

Objective To investigate the effect of dexmedetomidine combined with sufentanil on etomidate induced myofasmia in elderly patients undergoing painless gastroscopy.MethodsNinety elderly patients with painless gastroscopy were selected and randomly divided into group A and group B,with 45 cases each.Group A received slow intravenous injection of sufentanil 0.1 μg/kg before gastroscope examination and etomidate 0.2 mg/kg after 2-3 min.Ingroup B,6-8 μg dexmedetomidine was injected into the intravenous channel by intravenous pump before gastroscopy,fol-lowed by slow intravenous injection of sufentanil 0.1 μg/kg and slow intravenous injection of etomidate 0.2 mg/kg after 2-3 min.The duration of sedation,examination time,waking time,departure time,additional etomidate ratio,periopera-tive hemodynamic changes,stress response,muscle fibrillation and adverse events were compared between the twogroups.ResultsThere was no significant difference in sedation duration,time of gastroscopy,recovery time,departuretime between the two groups(P>0.05).The proportion of additional etomidate in group B was lower than that in group A(P<0.05).Compared with those before anesthesia,RR,MAP and HR of the two groups all changed to different degrees atthe time of setting the mirror,the body of the mirror to epigerosis,and at the end of examination,but group B was more sta-ble than group A(P<0.05).The levels of CRP,Cor and NE after gastroscopy were higher than those before gastroscopy inboth groups(P<0.05),but the levels in group B were lower than those in group A(P<0.05).The incidence of muscle fi-brillation in group B was lower than that in group A(P<0.05).The incidence of intraoperative cough and intraoperative ag-itation in group A was higher than that in group B(P<0.05).ConclusionIn painless gastroscopy,dexmedetomidinecombined with sufentanil has a good effect on the prevention of etomidate induced myofasmia,with a low incidence of adverse events and a certain clinical promotion value.