依托咪酯复合布托啡诺与丙泊酚复合芬太尼用于老年患者无痛胃肠镜检查中的临床观察比较(1)
摘要：目的 比较依托咪酯脂肪乳复合酒石酸布托啡诺与丙泊酚复合枸橼酸芬太尼两组药物配伍用于老年患者无痛胃肠镜检查的临床观察。 方法 选取100例ASAⅠ至Ⅱ级自愿接受无痛胃肠镜检查的老年患者，随机均分为依托咪酯脂肪乳+布托啡诺组(Y组，n=50)：使用药物为依托咪酯脂肪乳0.2 mg/kg+布托啡诺0.5 mg+咪达唑仑1 mg；丙泊酚+芬太尼组(B组，n=50)：使用药物为丙泊酚2mg/kg+芬太尼50ug+咪达唑仑1mg.。两组给药方式均采用静脉缓慢注入，术中根据患者体动或者呛咳情况追加静脉麻醉药，为初始剂量的1/3～1/4用以维持麻醉深度。分别观察、记录两组患者注射药物前(T0)，注射药物后2min(T1)，4 min(T2)，检查完毕后(T3)等不同时间点的心率(HR)、脉搏血氧饱和度(SPO2)、平均动脉压(MAP)、意识消失时间，停止给药至检查后指令睁眼的间隔时间(苏醒时间)，停止给药至完全清醒的间隔时间(离院时间)，以及呼吸暂停发生率，恶心呕吐、注射痛、肌颤等不良反应。结果 Y，B两组意识消失时间，苏醒时间，恶心呕吐没有明显差异，比较无统计学意义(P>0.05)。Y组(依托咪酯脂肪乳+布托啡诺组)的心率(HR)、脉搏血氧饱和度(SPO2)、平均动脉压(MAP)均较平稳，呼吸暂停发生率低、注射痛优于B组(丙泊酚+芬太尼组)，具有统计学意义(P<0.05)。B组的离院时间、肌颤优于Y组，具有统计学意义(P<0.05)。结论 两组配方均能满足临床要求，安全、顺利完成老年患者无痛胃肠镜检查。但是依托咪酯脂肪乳对老年患者心血管系统的影响明显小于丙泊酚，布托菲诺对老年患者呼吸抑制的影响小于芬太尼。因此依托咪酯脂肪乳+布托啡诺更适用于老年患者无痛胃肠镜检查，它呼吸抑制轻，心血管影响小，更利于麻醉安全与麻醉管理。
, 百拇医药
关键词：依托咪酯脂肪乳；丙泊酚；布托啡诺；芬太尼；老年患者无痛胃肠镜检查
Etomidate Combined Butorphanol and Propofol and Fentanyl Used in Clinical Comparison of Painless Gastrointestinal Endoscopy in Elderly Patients
CHEN Lei
(Department of Anesthesiology，Deyang Sixth People's Hospital，Deyang 618000，Sichuan，China)
Abstract：Objective To compare the two groups of drug combination of etomidate fat emulsion compounding tartaric acid Bhutto butorphanol and propofol compound citric acid fentanyl for clinical observation of elderly patients with painless gastrointestinal endoscopy. Methods A total of 100 cases of ASA I to II level voluntarily accept painless gastrointestinal endoscopy in elderly patients， were randomly divided into etomidate fat emulsion + butorphanol group (Y group， n = 50)： the use of drugs had more than midazolam 1mg in etomidate fat emulsion 0.2mg/kg+ butorphanol 0.5mg MI； Propofol + fentanyl group (group B， n = 50)： the use of drugs had more than midazolam 1mg in propofol 2mg/kg+ fentanyl 50ug+ MI. The two groups were treated with intravenous infusion of intravenous injection， and intravenous anesthesia was used to maintain the depth of anesthesia for the initial dose of 1/4 to 1/3. Were observed and recorded before the two groups of patients with drug injection (T0)， 2 min after drug injection (T1)， 4min (T2)， after the inspection is completed (T3) at different time points of the heart rate (HR)， pulse oxygen saturation (SpO2)， mean arterial pressure (map)， the time of loss of consciousness， to stop after delivery to the check instruction opening time interval (recovery time)， stop was administered to fully awake time interval (time from the hospital)， and respiratory pause incidence， nausea and vomiting， injection pain， muscle tremors and other adverse reactions. Results Y， B two groups of consciousness disappearance time， recovery time， nausea and vomiting were not significantly different， compared with no statistical significance (P > 0.05). Y group (etomidate fat emulsion butorphanol + group)， heart rate (HR)， pulse oxygen saturation (SpO2)， mean arterial pressure (map) were stable， apnea occurrence rate is low， injection pain is better than that of group B (propofol + fentanyl group)， with significant difference (P < 0.05). In the B group， the time of the hospital and the muscle was better than the Y group， with statistical significance (P < 0.05). Conclusion The two groups can meet the clinical requirements， safety and smooth completion of elderly patients with painless gastrointestinal endoscopy. But effects of etomidate fat emulsion on cardiovascular system in elderly patients was significantly lower than that of propofol and butorphanol on elderly patients with respiratory inhibition effect than fentanyl. Therefore etomidate fat emulsion butorphanol + more applicable to elderly patients with painless gastrointestinal endoscopy， respiratory inhibition of light， the cardiovascular effects of small， more conducive to the safety of anesthesia and anesthetic management., 百拇医药(陈磊)
, 百拇医药
关键词：依托咪酯脂肪乳；丙泊酚；布托啡诺；芬太尼；老年患者无痛胃肠镜检查
Etomidate Combined Butorphanol and Propofol and Fentanyl Used in Clinical Comparison of Painless Gastrointestinal Endoscopy in Elderly Patients
CHEN Lei
(Department of Anesthesiology，Deyang Sixth People's Hospital，Deyang 618000，Sichuan，China)
Abstract：Objective To compare the two groups of drug combination of etomidate fat emulsion compounding tartaric acid Bhutto butorphanol and propofol compound citric acid fentanyl for clinical observation of elderly patients with painless gastrointestinal endoscopy. Methods A total of 100 cases of ASA I to II level voluntarily accept painless gastrointestinal endoscopy in elderly patients， were randomly divided into etomidate fat emulsion + butorphanol group (Y group， n = 50)： the use of drugs had more than midazolam 1mg in etomidate fat emulsion 0.2mg/kg+ butorphanol 0.5mg MI； Propofol + fentanyl group (group B， n = 50)： the use of drugs had more than midazolam 1mg in propofol 2mg/kg+ fentanyl 50ug+ MI. The two groups were treated with intravenous infusion of intravenous injection， and intravenous anesthesia was used to maintain the depth of anesthesia for the initial dose of 1/4 to 1/3. Were observed and recorded before the two groups of patients with drug injection (T0)， 2 min after drug injection (T1)， 4min (T2)， after the inspection is completed (T3) at different time points of the heart rate (HR)， pulse oxygen saturation (SpO2)， mean arterial pressure (map)， the time of loss of consciousness， to stop after delivery to the check instruction opening time interval (recovery time)， stop was administered to fully awake time interval (time from the hospital)， and respiratory pause incidence， nausea and vomiting， injection pain， muscle tremors and other adverse reactions. Results Y， B two groups of consciousness disappearance time， recovery time， nausea and vomiting were not significantly different， compared with no statistical significance (P > 0.05). Y group (etomidate fat emulsion butorphanol + group)， heart rate (HR)， pulse oxygen saturation (SpO2)， mean arterial pressure (map) were stable， apnea occurrence rate is low， injection pain is better than that of group B (propofol + fentanyl group)， with significant difference (P < 0.05). In the B group， the time of the hospital and the muscle was better than the Y group， with statistical significance (P < 0.05). Conclusion The two groups can meet the clinical requirements， safety and smooth completion of elderly patients with painless gastrointestinal endoscopy. But effects of etomidate fat emulsion on cardiovascular system in elderly patients was significantly lower than that of propofol and butorphanol on elderly patients with respiratory inhibition effect than fentanyl. Therefore etomidate fat emulsion butorphanol + more applicable to elderly patients with painless gastrointestinal endoscopy， respiratory inhibition of light， the cardiovascular effects of small， more conducive to the safety of anesthesia and anesthetic management., 百拇医药(陈磊)