CAJ | 학술논문

目的：观察依托咪酯复合舒芬太尼用于无痛肠镜的临床效果及安全性。方法将2010年9月至2012年3月该院收治的80例自愿行无痛肠镜检查患者分为A组和B组，各40例，美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级。A组单独使用依托咪酯麻醉；B组检查前先给予枸橼酸舒芬太尼0.05μg/kg，2 min后再给予依托咪酯0.2~0.3 mg/kg进行麻醉。比较患者麻醉诱导开始前（T0）、诱导完成后（T1）、检查操作开始时（T2）、术毕时（T3）两组心率（HR）、血压、脉搏血氧饱和度（SpO2）、麻醉诱导时间、苏醒时间以及胃肠道反应、疼痛情况。结果 A组HR、血压诱导后T1时较T0时均有所下降，但均在正常范围之内；B组诱导后T1与T0时HR、血压比较，差异均无统计学意义（P>0.05）；两组T1、T2时HR、血压均有所下降，与T0比较，差异均有统计学意义（P<0.05）；在 T1、T2时A 组 HR、血压均低于 B 组，差异有统计学意义（P<0.05）；T0、T3时两组HR、血压比较，差异均无统计学意义（P>0.05）。两组各时间点SpO2值比较，差异无统计学意义（P>0.05）。A组依托咪酯用量[（58.4±6.1）mg]高于B组[（38.2±2.6）mg]，差异有统计学意义（P<0.05）；A组苏醒时间[（7.9±5.6） min]长于B组[（3.7±1.5）min]，差异有统计学意义（P<0.05）。两组患者在肠镜检查后发生恶心、呕吐方面比较，差异均无统计学意义（P>0.05）；两组患者肠镜检查后疼痛比较，术后0.5 h及术后2.0 h疼痛B组明显优于A组，差异均有统计学意义（P<0.05）。结论依托咪酯复合小剂量舒芬太尼用于无痛肠镜麻醉具有良好的镇痛效果及减少胃肠反应，是一种安全、有效的麻醉方法。
목적：관찰의탁미지복합서분태니용우무통장경적림상효과급안전성。방법장2010년9월지2012년3월해원수치적80례자원행무통장경검사환자분위A조화B조，각40례，미국마취의사협회（ASA）분급Ⅰ~Ⅱ급。A조단독사용의탁미지마취；B조검사전선급여구연산서분태니0.05μg/kg，2 min후재급여의탁미지0.2~0.3 mg/kg진행마취。비교환자마취유도개시전（T0）、유도완성후（T1）、검사조작개시시（T2）、술필시（T3）량조심솔（HR）、혈압、맥박혈양포화도（SpO2）、마취유도시간、소성시간이급위장도반응、동통정황。결과 A조HR、혈압유도후T1시교T0시균유소하강，단균재정상범위지내；B조유도후T1여T0시HR、혈압비교，차이균무통계학의의（P>0.05）；량조T1、T2시HR、혈압균유소하강，여T0비교，차이균유통계학의의（P<0.05）；재 T1、T2시A 조 HR、혈압균저우 B 조，차이유통계학의의（P<0.05）；T0、T3시량조HR、혈압비교，차이균무통계학의의（P>0.05）。량조각시간점SpO2치비교，차이무통계학의의（P>0.05）。A조의탁미지용량[（58.4±6.1）mg]고우B조[（38.2±2.6）mg]，차이유통계학의의（P<0.05）；A조소성시간[（7.9±5.6） min]장우B조[（3.7±1.5）min]，차이유통계학의의（P<0.05）。량조환자재장경검사후발생악심、구토방면비교，차이균무통계학의의（P>0.05）；량조환자장경검사후동통비교，술후0.5 h급술후2.0 h동통B조명현우우A조，차이균유통계학의의（P<0.05）。결론의탁미지복합소제량서분태니용우무통장경마취구유량호적진통효과급감소위장반응，시일충안전、유효적마취방법。
Objective To observe the clinical effects and safety of etomidate combined with sufentanil for painless colonoscopy. Methods A total of 80 patients underwent painless colonoscopy voluntarily were randomized into group A and group B,40 cases in each group from gradeⅠ-gradeⅡaccording to the American Society of Anesthesiologists(ASA). The group A used etomidate alone;while the group B was subject to 0.05 sufentanil citrate before examination ,then narcotized by etomidate. The hear rate(HR),blood pressure,saturation of pulse oximetry(SpO2),gastrointestinal reaction and so on in the two groups were compared. Results After induction,the values of HR and blood pressure at T1 were both lower than those at T0 in group A both decreased,but both were within the normal range. The comparison on HR and blood pressure at T1 and T0 in group B after induc-tion had no statistically significant difference(P>0.05);the values of HR and blood pressure at T1 and T2 in both groups were lower than those at T0 with statistically significant difference(P<0.05);the values of HR and blood pressure at T1 and T2 in group A was both lower than those in group B with statistically significant difference (P<0.05);the comparison on HR and blood pressure in the two groups at T0 and T3 had no statistically significant difference(P>0.05). The comparison of SpO2 value at different time in the two groups had no statistically significant difference (P>0.05). The dosage of etomidate in group A[(58.4±6.1)mg] was obviously more than that in group B [(38.2±2.6)mg] with statistically significant difference(P<0.05). The awakening time in group B[(3.7± 1.5)min] was obviously shorter than that in group A[(7.9±5.6)min] with statistically significant difference(P<0.05). The compari-son between the two groups on nausea and vomiting after colonoscopy had no statistically significant difference (P>0.05). The pain in group 0.5 h and 2.0 h after surgery in group B was prior to that in group B with statistically significant difference (P<0.05). Conclusion The application of etomidate combined with small dose of sufentanil for anesthesia of painless colonoscopy has good analgesic effect,which can reduce gastrointestinal reaction with security and effectiveness.