结肠镜检中丙泊酚和瑞芬太尼与咪达唑仑和芬太尼镇静的随机对照双盲研究  

作　　者：Jeff E. Mandel Jonathan W. Tanner Gary K Lichtenstein David C. Metz David A. Katzka Gregory G. Ginsberg Michael L. Kochman 肖玮(译) 王天龙(校) 

机构地区：[1]Departments of Anesthesiology and Critical Care [2]Departments of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania [3]不详

出　　处：《麻醉与镇痛》2009年第1期63-67,共5页Anesthesia & Analgesia

摘　　要：背景丙泊酚用于患者自控镇静（patient-controlled sedation，PCS）可解决中度镇静治疗窗窄的问题，但之前的研究存在方法学的不足。本研究中，我们使用瑞芬太尼＋丙泊酚经PCS给予，我们发现与芬太尼＋咪达唑仑相比，瑞芬太尼＋丙泊酚更方便使用。方法将50例择期结肠镜检的患者随机（使用盲法）分为咪达唑仑＋芬太尼组（MF组）或丙泊酚＋瑞芬太尼组（PR组），药物均经PCS给予。研究中评估项目有：镇静起效时间、恢复时间、患者满意度、护士满意度、镜检医师满意度、是否需要麻醉医师干预。结果与MF组相比，PR组患者进入镇静状态与恢复明显较快（P〈0．0001）。在PR组中，恢复时间短于操作时间。两组间患者满意度、护士满意度、镜检医师满意度相同。PR组中，有2例患者因为动脉氧饱和度低于设置的安全终点而需要麻醉医师干预。结论在适当的监护条件下，丙泊酚＋瑞芬太尼用于PCS比咪达唑仑＋芬太尼更有优势。BACKGROUND： Patient-controlled sedation （PCS） with propofol has been advocated as a method for dealing with the narrow therapeutic window for moderate sedation, but previous studies have methodologic limitations. We hypothesized that, by using remifentanil in conjunction with propofol and using PCS in both arms of the study, we could demonstrate marked improvements in facility use compared with fentanyl plus midazolam. METHODS： Fifty patients undergoing elective colonoscopy were randomized （with concealed allocation） to midazolam/fentanyl （group MF） or propofol/ remifentanil （group PR） administered via PCS. Time intervals for sedation and recovery, perceptions by patient, nurse, and gastroenterologist, and need for anesthesiologist intervention were assessed. RESULTS： Group PR patients were sedated and recovered significantly more rapidly than did group MF （P 〈 0. 0001 ）. In the group PR, recovery room time was actually shorter than procedure room time. Patient, nurse, and gastroenterologist perceptions were equivalent between the groups. Two patients in group PR required anesthesiologist intervention for arterial desaturation exceeding the primary safety end point. CONCLUSIONS： PIES with propofol/remifentanil yields superior facility throughput compared with midazolam/fentanyl when used in an appropriate care setting.

关 键 词：患者自控镇静 瑞芬太尼 咪达唑仑 结肠镜检 随机对照 丙泊酚 双盲研究 患者满意度 

分 类 号：R614[医药卫生—麻醉学] R971.2[医药卫生—外科学]