瑞芬太尼和芬太尼在老年无痛结肠镜检查中的比较研究  

Comparative study of remifentanil and fentanyl used in painless colonoscopy of elderly patients

作　　者：封卫征[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,201800 [2]上海交通大学医学院附属仁济医院麻醉科

出　　处：《上海医学》2007年第2期100-103,共4页Shanghai Medical Journal

摘　　要：目的观察比较瑞芬太尼和芬太尼用于老年患者无痛结肠镜检查的有效性和安全性。方法60例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、行无痛结肠镜检查的老年患者(>65岁),随机均分为瑞芬太尼(R)组和芬太尼(F)组。两组丙泊酚负荷剂量为0．8 mg／kg,推注时间为60 s,维持量为6 mg·kg-1·h-1;R组瑞芬太尼负荷剂量为0．5μg／kg,维持量为0．06μg·kg-1·min-1;F组单次予芬太尼1μg／kg;所有维持量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10 mg,观察血压(BP)、脉搏血氧饱和度(SpO2)、心率(HR)、双频指数(BIS)、呼吸频率(RR)、潮气量(VT)、呼气末二氧化碳(ETCO2)、起效时间、人镜时间、苏醒时间、镇静评分、定向力恢复、术后视觉模拟评分、麻醉效果分级、离院时间及不良反应。结果两组术中的BP、SpO2、HR、BIS、RR、VT、ETCO2与术前比较差异均有统计学意义(P<0．05或<0．01)。镜检开始3、5、10 min, F组BP、BIS明显低于R组,HR明显快于R组(P值分别<0．05、0．01)。R组丙泊酚追加用量明显少于F组(P<0．01),体动反应少于F组。术中所有患者均有不同程度的呼吸变慢、变浅,RR、VT较术前明显下降(P值分别<0．05、0．01),ETCO2逐渐升高。结论瑞芬太尼相对于芬太尼更适宜用于门诊老年无痛肠镜检查,但要注意呼吸抑制的发生。Objective To compare the validity and security of remifentanil and fentanyl used for painless colonoscopy in elderly patients. Methods Sixty ASA Ⅰ-Ⅱ elderly patients （〉 65 years） undergoing painless colonoscopy were randomized into two groups（n = 30 in each）. All patients were given propofol 0.8 mg/kg for 60 s and 6 mg·kg^-1·h^-1 individually. Patient in group R was given remifentanil 0.5μg/kg for 60 s which was infused continuously at a rate of 0.06/μg· kg^-1 ·min^-1. In group F, fentanyl was given 1μg/kg only. The maintaining infusions of propofol and remifentanil were carried out till the colonoscopic tube reached the ileocecal valve. Bolus propofol 10 mg was added according to the patients reactivity. Blood pressure（BP）, saturation of oxygen （SpO2）, heart rates（HR）, bispectral index（BIS）, respiratory rates（RR）, tidal volume（VT）, end tidal carbon dioxide（ETCO2）, time of onset, beginning and recovery, sedative scores, recovery of orientation, postoperative visual analogue scale（VAS）, anesthetic effect, duration of hospital stay and side effects were observed. Results BP, SpO2, HR, BIS, RR, VT, ETCO2 changed significantly in both groups（P 〈 0.05, P 〈 0.01）. BP and BIS were lower in group F, but HR was slower in group R 3, 5, 10 min after the beginning of colonoscopy（P 〈 0.05, P 〈 0.01） in comparing with the preoperative ones. The added dose of propofol in group F was larger than that in group R with more body reactive movements in group F. Respiratory depression marker as RR and VT dropped and ETCO2 increased, comparing to preoperative status in both groups. Conclusion Remifentanil is more eligible for elderly patients undergoing painless colonoscopy when combined with propofol, but inhibition of respiration should be noticed carefully. （Shanghai Med J, 2007, 30：100-103）

关 键 词：瑞芬太尼 丙泊酚 结肠镜 老年 

分 类 号：R574.62[医药卫生—消化系统]