丙泊酚配伍瑞芬太尼、氯胺酮用于无痛胃肠镜检查的研究  

Propofol Alone Versus Propofol in Combination with Remifentanil or Ketamine for Analgesia during Gastroscopy and Colonoscopy.

作　　者：徐鑫[1] 张媛[1] 李勇[1] 郑曼[1] 汪小海[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《医学研究杂志》2011年第4期105-108,共4页Journal of Medical Research

摘　　要：目的探讨丙泊酚配伍小剂量瑞芬太尼或小剂量氯胺酮在无痛胃肠镜检查中的镇静、镇痛效果和安全性。方法 726例自愿行无痛胃镜(n=417)及结肠镜(n=309)检查的患者分别分为1、2、3组:1组患者单纯静脉经泵注射丙泊酚(200ml/h),2组患者先静脉注射瑞芬太尼10μg,然后注射丙泊酚,3组患者先静脉注射氯胺酮0.2mg/kg,然后用泵注射丙泊酚。所有患者丙泊酚注射至睫毛反射消失、全身肌肉松弛时,内镜医生开始内镜检查,此时的丙泊酚使用剂量记为初始有效剂量。检查中如有体动或吞咽反射则追加丙泊酚0.5mg/kg,所有检查超过5min则接用丙泊酚3μg/(kg.min)维持,其中结肠镜检查患者时间超过10min时追加瑞芬太尼5μg,不再追加氯胺酮。观察各组患者麻醉诱导前后血压、心率及麻黄碱、阿托品使用率,记录丙泊酚初始有效剂量和使用总量、意识恢复时间和恢复正常行走时间;同时记录丙泊酚注射痛、体动发生率、呼吸暂停、喉痉挛等不良反应发生率。结果所有患者顺利完成内镜检查,无喉痉挛发生,患者满意度100%。1、2组患者麻醉诱导后血压、心率显著下降,而3组血流动力学平稳。2、3组体动和呼吸暂停发生率显著低于1组。胃镜检查中,2组苏醒最快,1、2组正常行走时间没有显著差异,3组苏醒时间和正常行走时间均显著长于1组和2组。肠镜检查中,3组苏醒和正常行走时间无显著差异。结论丙泊酚配伍小剂量瑞芬太尼可以减少内镜检查时丙泊酚初始有效剂量及使用总量;减少注射痛、体动以及呼吸暂停的发生,同时缩短恢复时间。丙泊酚配伍小剂量氯胺酮可以提供稳定的呼吸、循环状态,同时减少丙泊酚初始有效剂量和使用总量;虽然延长胃镜检查者恢复时间,但并不延长肠镜检查者恢复时间。Objective To compare the clinical efficacy and safety of propofol-ketamine or propfol-remifantanil with propofol in patients undergoing diagnostic gastrointestinal endoscopy.Methods 726 ASA I–II,aged 12 to 79-year-old patients scheduled for gastroscopy（417） or colonoscopy（309） were randomly allocated into group 1,group 2 and group 3,respectively.Patients received propofol 200ml/h in group 1,remifentanil 10μg followed by propofol in group 2,and ketamine 0.2mg/kg followed by propofol in group 3.The subsequent doses of propofol were 0.5 mg/kg when the patient was conscious or body movement appeared.Five minutes after the initial drug,the anesthesia was maintained with porpofol 3μg/kg/min,and withdrawed together with the endoscope.Heart rate（HR）,systolic blood pressure（SBP）,peripheral oxygen saturation（SpO2）,the initial and total consumption of propofol,time to conscious and time to ambulate of all patients were recorded.Side effects as transfusion pain,body movement,apnea and laryngospasm were also recorded.Results All the endoscopy tests were accomplished satisfactorily,and no laryngospasm was recorded.The HR and SBP decreased significantly after the induction in group 1 and group 2 than before,while the hemodynamics were stable in group 3.The incidence of movements and apnea were much less in group 2 and group 3 than in group 3.In gastroscopy patients,time to conscious in group 2 was the shortest,while time to ambulate in group 1 and group 2 showed no significant difference.Both time to conscious and time to ambulate in group 3 were the longest in gastroscopy among those three groups.In colonoscopy,there was no significant difference of recovery variables among those three groups.Conclusion Both the combination of remifentanil and propofol and the combination of ketamine and propofol for deep sedation in spontaneously breathing patients,offered better conditions for gastroscopy and colonoscopy than propofol used as a single drug.Remifentanil may decrease and ketamine may increase the time t

关 键 词：丙泊酚 瑞芬太尼 氯胺酮 胃镜 结肠镜 

分 类 号：R656[医药卫生—外科学]