布托啡诺与芬太尼联用丙泊酚在无痛肠镜检查中的应用比较  

Comparison of butorphanol and fentanyl for patients undergoing painless colonoscopy when both combined with propofol

作　　者：郑周鹏[1] 柳子明[1] 范雯[1] 陈亚秋[1] 周国军[1] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州310009

出　　处：《上海医学》2010年第4期346-349,共4页Shanghai Medical Journal

摘　　要：目的比较布托啡诺与芬太尼分别联用丙泊酚在无痛纤维结肠镜检查中的临床效果。方法选择行纤维结肠镜检查且主动要求施行腹痛腹静的患者60例,随机分为布托啡诺组(B组)和芬太尼组(F组),每组30例。B组患者静脉注射布托啡诺1mg,F组患者静脉注射芬太尼0.05mg,之后两组患者均静脉注射丙泊酚1～2mg/kg。术中丙泊酚以2～4mg.kg-1.h-1的速率静脉输注以维持麻醉深度。分别记录注射药物前、注射药物后2min、纤维结肠镜置入及纤维结肠镜退出等不同时间点的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),记录术中丙泊酚用药总量、停止给药至术后指令睁眼的间隔时间(苏醒时间)、停止给药至离院的间隔时间(离院时间),停药后20min内每隔5min采用Ramsay评分法测定患者的镇静水平,观察术中和术后发生的不良反应。结果两组注射药物后2min时的HR、MAP和SpO2均较注射药物前显著下降(P值均<0.05),注射药物后2min时F组的SpO2显著低于B组(P<0.05)。两组间手术时间、丙泊酚用量及苏醒时间的差异均无统计学意义(P值均>0.05),B组的离院时间显著长于F组(P<0.05)。两组患者在停药后5和10min时的Ramsay评分的差异无统计学意义(P值均>0.05),但在停药后15和20min时B组的Ramsay评分显著高于F组(P值均<0.05)。两组间不良反应发生率的差异无统计学意义(P>0.05)。结论布托啡诺或芬太尼联用丙泊酚应用于无痛纤维结肠镜检查均安全、有效,但布托啡诺的呼吸抑制轻,在麻醉安全和麻醉管理方面更具优势。Objective To compare the clinical efficacies of butorphanol and fentanyl when both of them combined with propofol for the patients undergoing painless colonoscopy.Methods Sixty patients of American Society of Anesthesiologists grades Ⅰ and Ⅱ,who asked for painless colonoscopy,were recruited in this study.The patients were randomly assigned to group B （1 mg butorphanol plus 1-2 mg/kg propofol,n=30） and group F （0.05 mg fentanyl plus 1-2 mg/kg propofol,n=30）.Anesthesia was maintained with propofol （2-4 mg·kg-1·h-1） during surgery.The heart rate （HR）,mean artery pressure （MAP）,and saturation pulse oxygen （SpO2） were recorded at different time points （before medication,2 min after medication,colonoscopy starting and colonoscopy ending）.We also recorded the total amount of propofol used,the interval of stopping administration to eye opening,and the time of hospital discharge.The sedation levels of the patients were observed every 5 min within 20 min after stopping medication using Ramsay score;the intra-and postoperative side effects were also observed.Results The HR,MAP and SpO2 were significantly decreased 2 min after medication in both group compared with those before medication （P0.05）.The HR and MAP were demographically similar between the 2 groups;while SpO2 was significantly lower in group F （P0.05） than in group B 2 min after stopping medication.The operation durations,amounts of propofol and recovery time were not significantly between the two groups （P0.05）.The Ramsay scores of group B were similar in the two groups at 5 and 10 min after stopping medication,but the score was significantly higher in group B than in group F at 15-20 min after stopping medication （P0.05）.The complication incidences were not significantly different between the two groups （P0.05）.Conclusion Butorphanol and fentanyl for patients undergoing painless colonoscopy is safe and effective when they are combined with propofol,but butorphanol has less inhibitory respiration,and it is th

关 键 词：布托啡诺 芬太尼 丙泊酚 肠镜检查 镇静 麻醉 

分 类 号：R614[医药卫生—麻醉学]