雷米芬太尼复合丙泊酚在老年患者无痛肠镜检查中的应用  

Application of remifentanil combined with propofol for colonoscopy in elderly patients

作　　者：封卫征[1] 祝义军[1] 周仁龙[2] 史东平[1] 杭燕南[2] 

机构地区：[1]上海交通大学医学院附属仁济医院嘉定分院麻醉科,上海市201800 [2]上海交通大学医学院附属仁济医院麻醉科

出　　处：《临床麻醉学杂志》2006年第5期342-344,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较不同剂量雷米芬太尼复合丙泊酚在老年患者无痛肠镜检查中的应用。方法60例ASAⅠ～Ⅱ级无痛肠镜检查老年患者(>65岁),随机分为三组。丙泊酚负荷剂量为0.8mg/kg、雷米芬太尼0.5μg/kg,静注时间各60s,丙泊酚维持量6mg·kg-1·h-1。A组雷米芬太尼维持量0.03μg·kg-1·h-1,B组0.06μg·kg-1·h-1,C组0.09μg·kg-1·h-1,持续输注至肠镜进至回盲部停药。根据患者反应,单次静脉追加丙泊酚10mg,观察并记录患者检查前、丙泊酚给药后、雷米芬太尼给药后、镜检开始后1、5min、退镜完毕后1、5min的MAP、SpO2、HR、BIS、RR、VT、PETCO2和麻醉起效时间、入镜时间、苏醒时间,镇静评分、定向力恢复、术后视觉模拟评分、离院时间以及不良反应。结果镜检中A组MAP、BIS低于B、C组(P<0.05),C组HR慢于A组(P<0.05)。各组给药后、镜检中的MAP、HR、BIS、RR、VT低于检查前(P<0.05,P<0.01),PETCO2高于检查前(P<0.05,P<0.01)。A组丙泊酚用量较B、C组大,苏醒时间、离院时间较B、C组长(P<0.05,P<0.01),BIS下降明显(P<0.05,P<0.01)。所有患者麻醉满意度为100%。结论雷米芬太尼0.06μg·kg-1·h-1配伍丙泊酚用于门诊老年患者无痛肠镜检查较为合适,但应注意注药速度,并加强监测,尽可能避免心动过缓和低血压的发生。Objective To compare the different dosages of remifentanil combined with propofol for colonoscopy in elderly patients. Methods Sixty ASA Ⅰ -Ⅱ elderly patients （〉65y） undergoing colonoscopy were randomized into three groups （n=20）. All patients were given propofol 0.8 mg/kg and remifentanil 0.5 μg/kg for bolus injection. The dosage of propofol for anesthesia maintenance was 6 mg·kg^-1·h^-1 and remifentanil 0.03 μg·kg^-1·h^-1 in group A, 0.06 μg·kg^-1·h^-1 in group B and 0.09 μg·kg^-1·h^-1 in group C until the operator saw the ileocaecal valve. Bolus propofol 10 mg was added if necessary. MAP, SpO2, HR, BIS, RR,VT, PETCO2, onset time, beginning of operation, recovery time, sedative scores, recovery of orientation, postoperative VAS, anesthetic effect, hospital stay time and side effects were recorded. Results During operation, the MAP in group A were lower than those in group B and C. HRs in group C were slower than those in group A. Compared to the preoperative, MAP, SpO2, HR, BIS, RR, VT, PET CO2 changed significantly during operation. The dosage of propofol in group A was the largest and the recovery time, hospital stay time were the longest. All patients were satisfied with anesthesia. Conclusion Remifentanil 0.06 μg·kg^-1·h^-1 combined with propofol is suitable for the elderly patients undergoing colonoscopy. But the infusion rate should be controlled and careful monitoring is necessary.

关 键 词：雷米芬太尼 丙泊酚 结肠镜 老年 

分 类 号：R574[医药卫生—消化系统] R573[医药卫生—内科学]