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内镜下食管黏膜切除术的麻醉方法比较

Anesthesia for esophageal endoscopic mucosal resection

摘要:

目的 比较早期食管癌及癌前病变内镜下食管黏膜切除术中2种静脉麻醉的应用效果及安全性.方法 140例早期食管癌及癌前病变行内镜下食管黏膜切除术的患者,随机分为2组,每组70例.Ⅰ组为咪唑安定+异丙酚,Ⅱ组为咪唑安定+依托咪酯.观察比较2组患者手术过程中生命体征、麻醉效果、清醒时间及术中、术后不良反应.结果 2种麻醉方式均能满足内镜治疗的需要.Ⅰ组患者治疗过程中血压、心率较检查前有不同程度的下降;Ⅱ组患者治疗过程中血压、心率相对平稳,与检查前比较差异无统计学意义,与Ⅰ组比较部分观察时点差异有统计学意义(P<0.05).2组患者血氧饱合度均在正常范围,苏醒时间差异无统计学意义.Ⅱ组患者肌震颤或阵挛发生率明显高于Ⅰ组,心动过缓及低血压发生率低于Ⅰ组,组间比较差异均有统计学意义(P均<0.05).少数患者术后有疼痛、恶心及头晕等不适,组间比较差异无统计学意义.结论 异丙酚和依托咪酯麻醉均能满足消化内镜治疗的要求,使用依托咪酯麻醉的患者血流动力学更平稳.

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abstracts:

Objective To observe efficacy and safety of 2 ways of intravenous anesthesia in endoscopic mucosal resection (EMR) for early esophageal cancer and its precancerous lesion.Methods A total of 140 patients with early esophageal cancer and its precancerous lesion undergoing EMR were enrolled and randomized into 2 groups, with 70 patients in each.Midazolam and propofol were used for group Ⅰ, while midazolam and etomidate were used for group Ⅱ.Vital signs, anesthetic effect, recovery time during the therapy, intra-operative and post-operative adverse reactions were compared.Results Anesthesia with both methods could reach the need for safe EMR.The blood pressure and heart rate of patients in group Ⅰ significantly decreased during the therapy, while no significant difference was found in those of group Ⅱ, but which was significantly different from those of group Ⅰ at some parts of the observation point (P<0.05).Pulse oxygen saturation of all patients during the procedure was within normal range.No significant difference was found between 2 groups in recovery time.The incidence of muscle tremor or myoclonus in group Ⅱ was significantly higher than that of group Ⅰ, but the incidence of bradycardia and hypotension in group Ⅱ was lower than that of group Ⅰ (P<0.05).Several patients complained pain, nausea and dizziness after therapy, but there was no significant difference between two groups. Conclusion Anesthesia with propofol and etomidate can both be applied to digestive endoscopy.Etomidate shows advantages in more stable hemodynamics.

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作者: 王海燕 [1] 刘晓艳 [1] 孙莉 [1]
期刊: 《中华消化内镜杂志》2011年28卷6期 320-322页 ISTICPKUCSCD
分类号: R735.1
栏目名称: 论著|%Original Articles
DOI: 10.3760/cma.j.issn.1007-5232.2011.06.006
发布时间: 2011-08-12
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