无痛肠镜患者不同剂量舒芬太尼鼻腔给药对丙泊酚用量的影响  

Influence of different dosage of intranasal sufentanil on propofol doses in patients undergoing fiberoptic colonoscopy

作　　者：苏凤荣[1] 林雪[2] 张瑞芹[2] 刘冬冬[2] 王树波[2] 

机构地区：[1]黑龙江省大庆市人民医院 [2]哈尔滨医科大学附属第二医院麻醉科

出　　处：《齐齐哈尔医学院学报》2009年第19期2358-2361,共4页Journal of Qiqihar Medical University

摘　　要：目的比较无痛肠镜患者不同剂量舒芬太尼鼻腔给药对丙泊酚用量的影响。方法择期无痛肠镜患者80例,ASAⅠ或Ⅱ级,年龄20～75岁,体重45～92kg,随机分为4组,每组20例。Ⅰ组经鼻滴入舒芬太尼0.05μg/kg,Ⅱ组、Ⅲ组和Ⅳ组分别经鼻滴入舒芬太尼0.075、0.1、0.125μg/kg。各组均静脉注射利多卡因50mg、丙泊酚1～3mg/kg,直至患者意识消失时置入纤维结肠镜进行检查,静脉输注丙泊酚50μg/kg.min维持麻醉。术中酌情追加丙泊酚0.5～1.0mg/kg。于给药前(T0)、舒芬太尼鼻腔给药后1、2min(T1～2)、静脉推注丙泊酚后(T3)、开始输注丙泊酚后1、2、3、4min(T4～7)及清醒时(T8)监测收缩压(SBp)、舒张压(DBp)、心率(HR)、脉搏血氧饱和度(SpO2),记录丙泊酚诱导量、总量、术中警觉-镇静评分(OAA/S)、体动反应、检查时间、清醒时间,记录术后恶心、呕吐及嗜睡等不良反应的发生情况。结果各组患者年龄、性别、ASA分级、体重、术中OAA/S评分、检查时间、清醒时间差异无统计学意义(P>0.05);与T0时相比,各组T2～8时SBp、DBp均不同程度降低,各组T3～4时SpO2有降低(P<0.05或0.01);与Ⅰ组相比,Ⅱ组、Ⅲ组和Ⅳ组丙泊酚诱导量、丙泊酚总量减少,差异有统计学意义(P<0.05);术后均未见恶心、呕吐及嗜睡等不良反应发生。结论舒芬太尼0.075～0.125μg/kg鼻腔给药配伍丙泊酚静脉给药用于无痛肠镜患者,丙泊酚用量适中。但丙泊酚应缓慢静脉推注,并严密监测患者生命体征。Objective To compare the dosage of propofol by different dosage intranasal sufentanil in patients undergoing fiberoptic colonoscopy. Methods Eighty ASA ⅠorⅡ patients aged 20- 75 yr weighing 45--92kg were randomly divided into 4 groups （n = 20 each ）：guoup I received intranasal instillation of sufentanil 0. 0,5 μg/kg; group Ⅱ , Ⅲ and IV received 0. 075,0.1 and 0. 125μg/kg respectively. Lidocaine 50 mg and propofol 1-3 mg/kg were then injected slowly until consciousness was lost and eyelash reflex disappeared. Fiberoptic colonoscopy was started. Sedation was maintained with continuous infusion of propofol 50 μg/kg · min. Intermittent boluses of propofol 0.5 · 1.0 mg/kg were given during operation when necessary. SBP,DBP, HR and SpO2 were continuously monitored and recorded before （To, baseline ）and 1,2 min after intranasal sufentanil （T1-2）and immediately after intravenous propofol（T3）and 1,2.3,4 min after continuous infusion of propofol （T4- 7 ）and when the patients were awake （T8）. The level of sedation was assessed using observer＇s assessment of alertness/sedation scale （OAA/ S）. Body movement in response to surgical stimuli,awakening time, side effects, the amount of propofol used for induction of sedation and the total amount of propofol used during operation were recorded and compared among the 4 groups. Results The 4 groups were compared with respect to age,sex,ratio,body weight and height. There were no significant differences in duration of colonoscopy,awakening time,and OAA/S scores among the 4 groups. There were no postoperative nausea, vomiting and somnolence. The amount of propofol used for induction and the total amount of propofol was significantly higher in group Ⅰ than in group Ⅱ , Ⅲ and Ⅳ. There was no significant difference in SpO2 at all 4 groups. But SpO2 was significantly lower at T3-4. SBP and DBP were significantly decreased at T2--8 as compared with the baseline at To in all 4 groups. Conclusions Sufentanil 0. 075-0. 125 μg/kg administer

关 键 词：舒芬太尼 鼻腔给药 丙泊酚 肠镜 无痛 

分 类 号：R614.24[医药卫生—麻醉学] R452[医药卫生—外科学]