不同给药方法在老年人结肠镜检查镇静中的应用  

Target-controlled infusion versus bolus injection of propofol in sedation for intestinal endoscopy in the elderly

作　　者：程锐铌[1] 左明章[1] 华震[1] 

机构地区：[1]卫生部北京医院麻醉科,北京100730

出　　处：《中国医刊》2012年第1期35-38,共4页Chinese Journal of Medicine

摘　　要：目的探讨不同给药方法在老年人结肠镜检查镇静中的应用效果。方法采用随机、对照方法,将60例老年结肠镜受检者随机分为三组:手控推注丙泊酚复合单次芬太尼组(B_(P+F)组),靶控输注丙泊酚复合单次芬太尼组(T_(P+F)组),丙泊酚复合瑞芬太尼双通路靶控输注组(T_(P+F)组)。记录检查过程中受检者血流动力学改变、镇静深度、药物用量和不良事件等。结果与B_(P+F)组比较,T_(P+F)组和T_(P+F)组诱导过程丙泊酚用量减少,镇静深度更适宜且术中低血压发生率明显降低,术后恢复时间明显缩短,三组间检查情况及其他不良事件差异无显著性。结论手控推注和靶控输注丙泊酚均可安全有效地用于老年人结肠镜检查镇静,但靶控输注可减少丙泊酚用量,使镇静深度更适宜,血流动力学更平稳,术后恢复更迅速。Objective The objective was to study the feasibility and safety of sedation with target-controlled infusion （TCI） and bolus injection of propofol combined with fentanyl and remifentanil in the elderly undergoing intestinal endoscopy. Methods In this prospective and randomised study, 60 patients scheduled for intestinal endoscopy were randomly assigned to Group B p＋F, Group Tp＋F and Group Tp＋R. Patients in Group B p＋r and Group Tp＋F received a single bolus of fentanyl combined with boluses and TCI propofol separately, while those in Group Tp ＋ R received TCI propofol and remifentanil. Blood pressure, heart rate, oximetry and BIS were monitored. Dosages of the drugs and all the complications were recorded. Results All the patients were adequately sedated. Dosage of propofol for induction in TCI groups was lower than that in Group Bp ＋ F （ P 〈 0. 05 ）. OAA/S scale and BIS in TCI groups were more suitable for the procedure than those in Group Bp＋F（P 〈0.01 ）. The incidence of hypotention in TCI groups was lower than that in Group BP＋F （ P 〈 0.01 ）. Time for recovery in TCI groups was shorter than that in Group By＋r （P 〈0.01 ）. Incidences of other complications were similar （P 〉 0.05 ）. Conclusions For the elderly undergoing intestinal endoscopy, sedation with boluses or TCI propofol combined with fentanyl and remifentanil is feasible and safe. It is more excellent for the TCI groups at lower dosage of propofol, lower incidence of hypotension and shorter discharge time.

关 键 词：丙泊酚 瑞芬太尼 靶控输注 内镜检查 安定镇痛 

分 类 号：R614.2[医药卫生—麻醉学]