【摘要】 目的 探究不同比例依托咪酯与丙泊酚混合液在无痛胃肠镜检查中对依托咪酯导致肌颤的影响。方法 选取2024年1月至6月期间行无痛胃肠镜检查者为研究对象，性别不限，年龄18～77岁，BMI 17～30 kg/m2,ASAⅠ或Ⅱ级。共纳入220例参与者，随机分为4组：依托咪酯组（E组）41例，依托咪酯与丙泊酚1∶1体积比混合组（EP1∶1组）62例，依托咪酯与丙泊酚1∶2体积比混合组（EP1∶2组）58例，依托咪酯与丙泊酚1∶3体积比混合组（EP1∶3组）59例。所有患者入室后常规监测生命体征，各组均按照0.15～0.2 mL/kg的剂量进行静脉注射麻醉诱导，静脉推药速度相同为0.4 mL/s，追加剂量0.05 mL/kg，待患者睫毛反射消失、全身肌肉放松达到目标镇静深度，开始进行内镜操作。观察肌颤的发生率及严重程度，比较各组患者麻醉诱导前（T1），麻醉诱导后2 min(T2)，麻醉诱导后5 min(T3)，麻醉诱导后10 min(T4)的平均动脉压（MAP），心率（HR），脉搏血氧饱和度（SpO2），苏醒时间，不良反应发生情况。结果EP1∶3组肌颤的发生率为37.3%，与E组（82.9%）、EP1∶1组（71.0%）、EP1∶2组（63.8%）比较，差异均有统计学意义，P<0.05。4组MAP在4个时间点均呈不同程度下降趋势，与EP1∶1组比较，EP1∶3组T2与T3时间点的MAP差异有统计学意义，P<0.05，但是下降范围均在基础血压20%的范围内；EP1∶3组与EP1∶2组4个时间点的MAP比较，差异无统计学意义，P> 0.05。4组受检者的HR在各时间点差异均无统计学意义，P>0.05。在T2时间点，E组与EP1∶3组比较，SpO2差异有统计学意义，P<0.05。EP1∶1组、EP1∶2组、EP1∶3组苏醒时间均短于E组，且与E组相比，EP1∶2组、EP1∶3组苏醒时间差异有统计学意义，P<0.05。与E组比较，EP1∶1组、 EP1∶2组、 EP1∶3组的术中呛咳，低血压，体动的发生率下降，差异有统计学意义，P<0.05。与E组比较，EP1∶2组和EP1∶3组术后恶心的发生率下降，差异有统计学意义，P<0.05。结论 在行无痛胃肠镜检查的麻醉中，依托咪酯与丙泊酚体积比例为1∶3时，可显著降低依托咪酯引起的肌颤发生率，同时可保持血流动力学的相对稳定，降低不良反应发生率。更多还原

【Abstract】 Objective To investigate the effect of different volume ratios of etomidate and propofol mixture on etomidateinduced myoclonus during painless gastrointestinal endoscopy. Methods Patients undergoing painless gastrointestinal endoscopy from January to June 2024 were selected as the research subjects with no gender restrictions. The patients were aged18 to 77 years, with BMI 17 to 30 kg/m~2 and ASA grade Ⅰ or Ⅱ. Totally, 220 patients were enrolled in the study and randomly divided into 4 groups: etomidate group(E group, n=41), etomidate and propofol 1∶1 volume ratio mixture group(EP1∶1group, n=62), etomidate and propofol 1∶2 volume ratio mixture group(EP1∶2 group, n=58), and etomidate and propofol1∶3 volume ratio mixture group(EP1∶3 group, n=59). After entering the operating room, all patients’ vital signs were routinely monitored. Each group was given intravenous anesthesia induction at a dose of 0.15 to 0.2 mL/kg, with a consistent intravenous injection speed of 0.4 mL/s. A supplementary dose of 0.05 mL/kg was given as needed until the loss of eyelash reflex and full muscle relaxation were achieved. Endoscopic procedure began at the targeted depth of sedation. The incidence and severity of myoclonus were observed, and mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation(SpO2),recovery time, and adverse reactions were compared at four time points: before anesthesia induction(T1), 2 minutes after anesthesia induction(T2), 5 minutes after anesthesia induction(T3), and 10 minutes after anesthesia induction(T4).Results The incidence of myoclonus in the EP1∶3 group was 37.3%, significantly lower than that in the E group(82.9%),EP1∶1 group(71%), and EP1∶2 group(63.8%)(P<0.05). MAP of all four groups showed a decreasing trend at the four time points, and the differences in MAP between the EP1∶3 group and the EP1∶1 group at T2 and T3 were statistically significant(P<0.05), but the decrease was within 20% of the baseline blood pressure. There were no statistically significant differences in MAP between the EP1∶3 group and the EP1∶2 group at the four time points. There was no significant difference in HR at four time points among the four groups(P>0.05). At T2 time point, there was statistical significance in SpO2 in group E compared with EP1∶3 group(P<0.05). The recovery time of the EP1∶1 group, EP1∶2 group, and EP1∶3 group was shorter than that of the E group, and the differences in recovery time between the EP1∶2 group, EP1∶3 group and the E group were statistically significant(P<0.05). Compared with the E group, the incidence of intraoperative coughing, hypotension, and body movement in the EP1∶1 group, EP1∶2 group, and EP1∶3 group decreased(P<0.05). Compared with the E group, the incidence of postoperative nausea in the EP1∶2 group and EP1∶3 group decreased, with statistically significant differences(P< 0.05).Conclusion In the anesthesia for painless gastrointestinal endoscopy, a 1∶3 volume ratio of etomidate and propofol can significantly reduce the incidence of etomidate-induced myoclonus, maintain relatively stable hemodynamics, and reduce the incidence of adverse reactions.更多还原