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1、老年无痛胃镜麻醉安全性体会【摘要】目的比较丙泊酚与依托咪酯联全应用能否扬长避短，使老年无痛胃镜检麻醉更平稳，减少麻醉相关并发症。方法300例老年患者择期行无痛胃镜检查术，采用抽签随机双盲法分为3组。A组：咪唑安定+丙泊酚+芬太尼；B组：咪唑安定+依托咪酯+芬太尼；C组：咪唑安定+芬太尼+丙泊酚+依托咪酯。术中监测ECG、BP、RR、SP02。观察术中体动、低氧血症、心动过缓、低血压、肌阵挛、术中遗忘及术后恶心呕吐、肌痛等不良反应。记录丙泊酚首次用量和总用量及依托咮酯首次用量及总用量，记录镜检时间、苏醒时间（从退出镜子到患者容易唤醒，服从
2、命令的时间）。结果三组术前血压、心率、SP02无显明差异，均顺利完成检查。A组麻醉前后心率、血压、SP02麻醉前后均有不同程度下降，有3例因SP02下降到85%以下而暂停检查，28例血压下降明显，低于警戒值而静注升压药。无术后恶心呕吐及肌痛等不良反应。B组麻醉前后心率、血压、SPO2变化不大，术中体动、肌松不良、肌阵挛、呛咳，及术后恶心躁动发生率较高。C组血压、心率、SP02较稳定，麻醉前后无明显差别。C组清醒时间明显缩短，丙泊酚依托咪酯用量明显减少。详见表1、表2、表3。结论丙泊酚联合依托咪酯伍用小剂量的芬太尼及咪唑安定平衡麻醉优势互
3、补、扬长避短，能使老年病人无痛胃镜检查时血压、心率更稳定，呼吸抑制更小，苏醒更快，降低了依托咪酯相关的肌阵挛以及术后恶心呕吐发生率。提高了老年无痛胃肠镜检的安全性和舒适性。【关键词】丙泊酚依托咪酯老年无痛胃镜分类号：R614ZZZZZ文献标识码：A文章编号：1005-0515(2011)6-009-02SafetyofoldergastroscopyanesthesiaexperienceHeFangkun(SichuanProvince,theSecondPeople'sHospitalofJintangCounty,Chengdu6
4、10401)[Abstract]ObjectiveTocomparepropofolandetomidate,allapplicationstogethercanexceedandpainlessgastroscopyexaminationofoldermorestableanesthesia,reduceanesthesia-relatedcomplications.Methods300casesofelderlypatientsundergoingelectivepainlessgastroscopy,randomizeddoubl
5、e-blindballotdividedinto3groups.A：Midazolam+propofol+fentanyl；Bgroup：midazolam,etomidate+fentanyl；CGroup：midazolam+fentanyl+propofol+etomidate.IntraoperativemonitoringofECG,BP,RR,SP02.Intraoperativeobservationofbodymovement,hypoxia,bradycardia,hypotension,myoclonus,intra
6、operativeandpostoperativenauseaandvomitingforgotten,musclepainandotheradversereactions.Recordandthefirstdosageofpropofolandetomidate,thetotalamountofthefirstamountandthetotalamount,recordexaminationtime,recoverytime(fromtheexitmirrorwereeasiertowakeup,obeyordersofthetime
7、).ResultsThepreoperativebloodpressure,heartrate,SPO2noobviousdifferences,boththesuccessfulcompletionofinspection.Agroupofanesthesiabeforeandaftertheheartrate,bloodpressure,SPO2weredecreasedafteranesthesia,3patientsdroppedto85%forSPO2suspendedthefollowingexamination,28pat
8、ientsbloodpressuredroppedsignificantly,lowerthanthewarningvalueofintravenousvasopressors.Nopostoperativ
