CAJ | 학술논문

目的：观察依托咪酯联合地佐辛用于老年无痛肠镜的麻醉效果。方法选择北海市人民医院2013年1~9月拟行无痛肠镜的老年患者120例，年龄65~84岁，ASAⅠ~Ⅱ级，体重41~68 kg，按照随机、双盲、对照的原则分为四组：丙泊酚-芬太尼组(A组)、丙泊酚-地佐辛组(B组)、依托咪酯-芬太尼组(C组)、依托咪酯-地佐辛组(D组)，每组30例；静注芬太尼1μg/kg或地佐辛1μg/kg，随后静注丙泊酚或依托咪酯乳化剂1 mL/5 s。鼻导管给氧，保留自主呼吸。记录麻醉诱导时间，丙泊酚或依托咪酯给药量，注射痛、肌痉挛的情况，肠镜检查的时间，离室时间，术中呼吸抑制，低血压，麻黄碱、阿托品的给药量及体动情况、内镜医师和麻醉医师的满意度；麻醉前、术中最低的收缩压、舒张压、心率、血氧饱和度、呼吸；术后恶心、呕吐、头晕等并发症情况。结果四组患者的麻醉诱导时间、注射痛、肌痉挛、体动情况、内镜医师的满意度比较差异无统计学意义(P>0.05)。与丙泊酚组(A、B组)比较，依托咪酯组(C、D组)患者术中呼吸抑制，低血压，麻黄碱、阿托品的给药量降低；麻醉医师的满意率增高；术中最低的收缩压、舒张压、心率、血氧饱和度、呼吸升高，术后恶心、呕吐、头晕等并发症增高；离室时间延长(P<0.05)。与C组比较，D组患者呼吸抑制更低(P<0.05)；D组术中呼吸与麻醉前比较差异无统计学意义(P>0.05)。结论依托咪酯联合地佐辛麻醉虽然术后恶心、头晕等并发症多，但呼吸、循环影响小，适用于老年无痛肠镜。
목적：관찰의탁미지연합지좌신용우노년무통장경적마취효과。방법선택북해시인민의원2013년1~9월의행무통장경적노년환자120례，년령65~84세，ASAⅠ~Ⅱ급，체중41~68 kg，안조수궤、쌍맹、대조적원칙분위사조：병박분-분태니조(A조)、병박분-지좌신조(B조)、의탁미지-분태니조(C조)、의탁미지-지좌신조(D조)，매조30례；정주분태니1μg/kg혹지좌신1μg/kg，수후정주병박분혹의탁미지유화제1 mL/5 s。비도관급양，보류자주호흡。기록마취유도시간，병박분혹의탁미지급약량，주사통、기경련적정황，장경검사적시간，리실시간，술중호흡억제，저혈압，마황감、아탁품적급약량급체동정황、내경의사화마취의사적만의도；마취전、술중최저적수축압、서장압、심솔、혈양포화도、호흡；술후악심、구토、두훈등병발증정황。결과사조환자적마취유도시간、주사통、기경련、체동정황、내경의사적만의도비교차이무통계학의의(P>0.05)。여병박분조(A、B조)비교，의탁미지조(C、D조)환자술중호흡억제，저혈압，마황감、아탁품적급약량강저；마취의사적만의솔증고；술중최저적수축압、서장압、심솔、혈양포화도、호흡승고，술후악심、구토、두훈등병발증증고；리실시간연장(P<0.05)。여C조비교，D조환자호흡억제경저(P<0.05)；D조술중호흡여마취전비교차이무통계학의의(P>0.05)。결론의탁미지연합지좌신마취수연술후악심、두훈등병발증다，단호흡、순배영향소，괄용우노년무통장경。
Objective To observe the anesthetic effect of indolent colonoscopy with Etomidate combined with Dezocine for elderly patients. Methods 120 elderly patients of Beihai People's Hospital from January to September 2013 sched-uled for indolent colonoscopy, ranging in age from 65 to 84, ASA Ⅰ-II, weight from 41 to 68 kg, were selected and divided into 4 groups according to the principle of random, control and double blinds: Propofol-Fentanyl (group A), Propofol-Dezocine (group B), Etomidate-Fentanyl (C group), Etomidate-Dezocine (group D), with 30 patients in each group. Intravenous Fentanyl 1μg/kg or Dezocine 1μg/kg was given, and then Propofol or Etomidate emulsifier 1 mL/5 s. Used nasal tube for oxygen provision, and kept spontaneous breathing. The time of anesthetic induction, dosage of Propofol or Etomidate, the state of injection pain and muscle spasm, the time of colonoscopy, departure time were recorded. During the surgery, respiratory depression, hypotension, dosage of ephedrine and atropine, body movement and the satisfaction of endoscopic physicians and anesthetist were also recorded. Meanwhile, less systolic pressure, di-astolic blood pressure, heart rate, oxyhemoglobin saturation and breathe before anesthetist and during the surgery and the complication after the surgery, such as nausea, emesis and dizziness, and so on were recorded. Results There were no statistical differences of induction time of anesthetic, injection pain, muscle spasm, body movement and the satisfac-tion of endoscope physicians in 4 groups patients (P> 0.05). Compared with Propofol group (group A, B), respiratory depression, hypotension, dosage of ephedrine and atropine of Etomidate group (group C, D) were lower. Less systolic pressure, diastolic blood pressure, heart rate, oxyhemoglobin saturation, breath during the surgery were increased; the departure time was extended (P<0.05). Respiratory depression of group D, compared to group C, was lower (P<0.05);there was no difference of the breath between during the surgery and before the anesthetic in group D (P>0.05). Con-clusion The anesthetic that combined Etomidate with Dezocine is appropriated to indolent colonoscope of elder pa-tients. It will cause less effect of breath and circulation, though there will be some complication of nausea, dizziness colonoscopy of elderly patients.