不同阿片类药物复合依托咪酯–丙泊酚在无痛胃肠镜麻醉效果和满意度比较
Comparison of the Effectiveness and Satisfaction of Different Opioids Combined with Etomidate-Propofol in Painless Gastroenteroscopy Anaesthesia

目的：比较等效剂量的舒芬太尼、瑞芬太尼、阿芬太尼联合丙泊酚–依托咪酯在无痛胃肠镜检查中的麻醉效果。方法：选择本院行无痛胃肠镜检查患者180例，随机分为S组、R组和A组，每组60例。第一种药物在1 min内完成泵注(S组泵注舒芬太尼稀释液0.05 μg/kg，R组泵注瑞芬太尼稀释液0.4 μg/kg，A组泵注阿芬太尼稀释液3 μg/kg)。第二种药物(依托咪酯–丙泊酚混合液)按0.2 ml/kg的诱导剂量在2 min内完成匀速泵注；待患者BIS值小于60时，开始行胃肠镜检查。记录镇静成功例数、诱导时间、苏醒时间、离室时间、检查时间、药物使用总量及不良事件。结果：三组患者镇静成功率差异无统计学意义(P > 0.05)。与S组相比，A组的诱导时间、苏醒时间和离室时间缩短(P < 0.05)；R组的诱导时间差异无统计学意义(P > 0.05)，R组的苏醒时间、离室时间缩短(P < 0.05)。与R组相比，A组的诱导时间、苏醒时间、离室时间差异无统计学意义(P > 0.05)。与S组相比，A组和R组眩晕发生率降低(P < 0.05)，A组患者注射痛发生率低于S组和R组(P < 0.05)；A组患者满意度明显高于S组和R组(P < 0.05)；三组患者的检查时间、EP混合液总消耗量及每公斤体重EP混合液消耗量差异无统计学意义(P > 0.05)。结论：在无痛胃肠镜检查中，与舒芬太尼药物复合方案相比，阿芬太尼和瑞芬太尼药物复合方案的恢复时间更短。同时，阿芬太尼可缩短诱导时间、降低注射痛发生率、提高患者满意度。综合考虑，阿芬太尼复合体积比1:2的依托咪酯–丙泊酚混合液是无痛胃肠镜检查时更优的药物复合方案。
Objective: To compare the anaesthetic effects of equivalent doses of sufentanil, remifentanil and alfentanil combined with propofol-etomidate in painless gastroenteroscopy. Methods: 180 patients who underwent painless gastroenteroscopy in our hospital were selected and randomly divided into Group S, Group R and Group A, with 60 cases in each group. The first medicine was pumped within 1 min (0.05 μg/kg of sufentanil dilution in Group S, 0.4 μg/kg of remifentanil dilution in Group R, and 3 μg/kg of alfentanil dilution in Group A). The second medicine (etomidate-propofol mixture) was pumped at a homogeneous rate in 2 min at an induction dose of 0.2 ml/kg; when the patient’s BIS value was less than 60, gastroenteroscopy was started. Record the number of successful sedation cases, induction time, wake time, departure time,examination time, total amount of medicines used and adverse reactions. Results: There was no significant difference in sedation success among the three groups (P > 0.05). Compared with group S, induction time, wake time and departure time were shorter in group A (P < 0.05); no significant difference in induction time in group R (P > 0.05), and wake time and departure time is shorter in group R (P < 0.05). Compared with group R, the induction time, wake time and departure time were no significant difference with group A (P > 0.05). Compared with S, the incidence of vertigo in groups A and R was lower (P < 0.05), and the incidence of injection pain was lower in group A than group S and group R (P < 0.05); patient satisfaction in Group A was significantly higher than group S and group R (P < 0.05); no differences in examination time, total EP mixture consumption and EP