CAJ | 학술논문

目的：探讨依托咪酯复合小剂量舒芬太尼在老年患者无痛肠镜检查麻醉中应用的安全性及效果。方法选取2013年8月~2014年10月在本院行肠镜检查的老年患者60例，ASAⅡ~Ⅲ级，随机分为P组（丙泊酚组）、E1组（依托咪酯组）、E2组（依托咪酯复合小剂量舒芬太尼组），P组予静脉缓慢注入丙泊酚1.5~2.5 mg/kg；E1组予静脉缓慢注入依托咪酯0.2~0.35 mg/kg；E2组先予静脉缓慢注入舒芬太尼0.1μg/kg，1 min后予依托咪酯0.1~0.3 mg/kg。记录麻醉前（T0）、给药后入镜前（T1）、入镜后2 min（T2）、入镜后5 min（T3）、检查结束（T4）、苏醒时（T5）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）以及麻醉苏醒时间、不良反应、患者满意度。结果与T0、T5时点比较，P组患者的HR、MAP在T1、T2、T3、T4时点下降明显，差异有统计学意义（P<0.05），与E1、E2组比较下降明显，差异有统计学意义（P<0.05）。 E1、E2组患者的注射痛发生率低于P组（P<0.05），P、E2组患者的恶心呕吐、术中体动、肌颤发生率明显低于E1组（P<0.05）。结论依托咪酯复合小剂量舒芬太尼用于老年患者无痛肠镜检查术，对心率和血压影响小，患者的呼吸循环功能更稳定，更适用于老年患者无痛肠镜检查。
목적：탐토의탁미지복합소제량서분태니재노년환자무통장경검사마취중응용적안전성급효과。방법선취2013년8월~2014년10월재본원행장경검사적노년환자60례，ASAⅡ~Ⅲ급，수궤분위P조（병박분조）、E1조（의탁미지조）、E2조（의탁미지복합소제량서분태니조），P조여정맥완만주입병박분1.5~2.5 mg/kg；E1조여정맥완만주입의탁미지0.2~0.35 mg/kg；E2조선여정맥완만주입서분태니0.1μg/kg，1 min후여의탁미지0.1~0.3 mg/kg。기록마취전（T0）、급약후입경전（T1）、입경후2 min（T2）、입경후5 min（T3）、검사결속（T4）、소성시（T5）적심솔（HR）、평균동맥압（MAP）、혈양포화도（SpO2）이급마취소성시간、불량반응、환자만의도。결과여T0、T5시점비교，P조환자적HR、MAP재T1、T2、T3、T4시점하강명현，차이유통계학의의（P<0.05），여E1、E2조비교하강명현，차이유통계학의의（P<0.05）。 E1、E2조환자적주사통발생솔저우P조（P<0.05），P、E2조환자적악심구토、술중체동、기전발생솔명현저우E1조（P<0.05）。결론의탁미지복합소제량서분태니용우노년환자무통장경검사술，대심솔화혈압영향소，환자적호흡순배공능경은정，경괄용우노년환자무통장경검사。
Objective To investigate the effect and safety of etomidate combined with sufentanyl in elderly patients un-dergoing palnless colonoscopic examination. Methods 60 elderly patients undergoing palnless colonoscopic examination in our hospital from August 2013 to October 2014 were selected,with ASalI-Ⅲ,were randomly divided into group P (propofol group),group E1 (etomidate group) and group E2 (etomidate combined with small doses sufentanyl group),20 cases in each group.Intravenous injection of propofol (1.5-2.5 mg/kg) was taken to group P,intravenous injection of eto-midate (0.2-0.35 mg/kg) was taken to group E1,group E2 were received intravenous injection of etomidate (0.1-0.3 mg/kg) af-ter who were given with sufentanyl (0.1μg/kg) for a minute.Before anesthesia (T0),after administration into the mirror before (T1),after the mirror 2 minites (T2),after the mirror 5 minites (T3),checking end (T4),wake up (T5),HR,MAP,SpO2 and the recovery time,adverse reactions,satisfaction among the three groups was observed. Results HR,MAP of group P at T1,T2,T3,T4 point dereased compared with that at T0,T5 point,the difference was significant (P<0.05),and HR,MAP of group P at T1,T2,T3,T4 point dereased compared with that of group E1 and group E2,the difference was significant (P<0.05).The incidence of injection paln in group E1,E2 was lower than that in group P (P<0.05).The incidence of nausea and vomiting,body movement,muscle trembling in group P and group E2 was lower than that in group E1 (P<0.05). Conclusion Etomidate combined with small doses sufentanyl can provide effective paln relief with fewer stimulation of the cardiovascular and respiratory system in the elderly patients with palnless colonoscopic examination.