依托咪酯与异丙酚用于上内镜复杂手术的镇静作用：前瞻性双盲随机对照试验
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Etomidate versus propofol sedation for complex upper endoscopic procedures: a prospective double-blinded randomized controlled trial
背景与目的
虽然越来越多的证据表明异丙酚诱导的深度镇静可以有效并且安全地进行，但是却经常观察到心肺不良事件发生。 依托咪酯是一种新兴药物，即使在高危患者群体中也能提供血流动力学和呼吸稳定性。 本研究的目的是比较依托咪酯和异丙酚用于内镜镇静的安全性和有效性。
方 法
共有128名接受超声内镜术（EUS）治疗的患者被随机分配接受由注册护士管理的依托咪酯组或异丙酚组。 主要结果是观察发生任何心肺不良反应事件的患者比例。
结 果
依托咪酯组22例(34.38%)，丙泊酚组33例(51.56%)，心肺不良事件发生率差异无统计学意义(PZ.074)。然而，与异丙酚组比较，依托咪酯组的氧饱和度降低的发生率(4/64 [6.25%]vs 20/64 [31.25%];pz.001)和呼吸抑制(5/64 [7.81%]vs 21/64 [32.81%];P Z.001)显著降低。依托咪酯组(22/64[34.37%])肌阵挛发生率明显高于异丙酚组(8/64 [12.50%])(P Z.012)。重复测量方差分析显示镇静组和时间对收缩压有显着影响（依托咪酯组大于异丙酚组）。依托咪酯组的医师满意度高于异丙酚组。
结 论
与异丙酚相比，依托咪酯呼吸抑制事件少，镇静效果好。然而，在内镜检查过程中，其更容易引发肌阵挛和血压升高。
原始文献摘要
Mi Gang Kim,, Se Woo Park, Jae Hyun Kim,et,al.Etomidate versus propofol sedation for complex upper endoscopic procedures: a prospective double-blinded randomized controlled trial[J]，GASTROINTESTINAL ENDOSCOPY2017；86：461.
Background and Aims: Although a growing body of evidence demonstrates that propofol-induced deep sedation can be effective and performed safely, cardiopulmonary adverse events have been observed frequently. Etomidate is a new emerging drug that provides hemodynamic and respiratory stability, even in high-risk patient groups. The objective of this study was to compare safety and efficacy profiles of etomidate and propofol for endoscopic sedation.
Methods: A total of 128 patients undergoing EUS were randomized to receive either etomidate or propofol blinded administered by a registered nurse. The primary outcome was the proportion of patients with any cardiopulmonary adverse events.
Results: Overall cardiopulmonary adverse events were identified in 22 patients (34.38%) of the etomidate group and 33 patients (51.56%) of the propofol group, without significant difference (PZ.074). However, the incidence of oxygen desaturation (4/64 [6.25%] vs 20/64 [31.25%]; P Z.001) and respiratory depression (5/64 [7.81%] vs 21/ 64 [32.81%]; P Z.001) was significantly lower in the etomidate group than in the propofol group. The frequency of myoclonus was significantly higher in the etomidate group (22/64 [34.37%]) compared with the propofol group (8/64 [12.50%]) (P Z.012). Repeated measure analysis of variance revealed significant effects of sedation group and time on systolic blood pressure (etomidate group greater than propofol group). Physician satisfaction was greater in the etomidate group than in the propofol group.
Conclusions: Etomidate administration resulted in fewer respiratory depression events and had a better sedative efficacy than propofol; however, itwasmore frequently associatedwithmyoclonus and increased blood pressure during endoscopic procedures.
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