3种镇痛药在无痛肠镜检查中的镇痛效果及安全性比较  

A comparison of analgetic effect and safety of three analgesics in the painless enteroscopy

作　　者：刘晓梅[1] 陈惠荣[1] 李军[1] 吕立波[1] 刘永勤[1] 

机构地区：[1]海军总医院麻醉科,北京100048

出　　处：《转化医学杂志》2013年第2期90-92,共3页Translational Medicine Journal

摘　　要：目的比较芬太尼、瑞芬太尼与舒芬太尼3种镇痛药在无痛肠镜检查中的镇痛效果及安全性。方法 150例拟行无痛肠镜检查的患者,随机分为芬太尼组(PF组)、瑞芬太尼组(PR组)和舒芬太尼组(PS组),每组50例。各组分别缓慢静注芬太尼0.8μg/kg、瑞芬太尼0.5μg/kg、舒芬太尼0.08μg/kg,后再静脉匀速推注丙泊酚1.5 mg/kg,睫毛反射消失后开始检查操作。术中视情况追加丙泊酚0.5～1.0 mg/kg。监测用药前、插镜时、给药5 min、术毕清醒时的心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、脉搏血氧饱和度(pulse oxygen saturation,SpO2),并记录停药睁眼时间、定向力恢复时间、丙泊酚总用量、清醒时疼痛评分、呼吸抑制发生情况。结果①各组内给药后各个时间点SBP、DBP、HR与给药前相比均下降(P<0.05),SpO2变化无统计学意义(P>0.05);各组间两两比较,相同时间点观察指标差异无统计学意义(P>0.05)。②与其他两组比较PS组疼痛评分最低(P<0.05),PF、PR两组相比差异无统计学意义(P>0.05)。③与其他两组比较PR组停药睁眼时间及定向力恢复时间最短(P<0.05),与其他两组比较PS组显著延长(P<0.05)。④与其他两组比较PR组丙泊酚总用量最少(P<0.05),PF、PS两组相比差异无统计学意义(P>0.05)。⑤PS组、PR组体动发生率明显低于PF组(P<0.05),3组呼吸抑制发生率差异无统计学意义(P>0.05)。结论芬太尼、瑞芬太尼、舒芬太尼3种镇痛药均能够安全用于无痛肠镜检查,但三者的镇痛效果、苏醒时间以及能否减少复合药丙泊酚的总用量等方面存在差异,麻醉医师应评估患者情况后合理选择镇痛药物。Objective To compare the analgetic effect and safety of fentanyl, refentanyl and sufentanil in painless enteroscopy. Methods One hundred fifty patients undergoing painless en teroscopy were randomly divided into three groups according to the analgesics, Group PF （0. 8μg/kg fentanyl,n=50） ,Group PR （0.5 μg/kg refentanyl,n=50） and Group PS （0.08μg/kg sufentanil, n=50）. Heart rate （HR）,systolic blood pressure （SBP）, diastolic blood pressure （DBP） and pulse oxygen saturation （SpO2） were monitored at different time points：before injection,inserting enteroscope, after injection 5 min, and awaken. Awaken time, total propofol, visual analogue score （VAS） , and adverse reaction were recorded. Results Significant decrease was found in levels of SBP, DBP and HR after injection in every group than those before injection （P〈0.05）, though no significant difference in SpO2 was detected （P〉0.05）. No significant difference was observed in SBP, DBP, HR and SpO2 levels at the same time in three groups （P〉0.05）. VAS of Group PS was significant lower compared with that of the other two groups （ P〈0.05 ）, and no significant difference in VAS at Group PF and Group PR was found （P〉0.05）. The eye-opening time and orientation recovery time were the shortest in Group PR, though those were the longest in Group PS （P〈0.05）. The total propofol of Group PR was the least in three groups （P〈0.05）. Body moving rates in Group PS and Group PR were significant lower than that in Group PF （P〈0. 05 ）. There was no significant difference in respiratory depression rate among three groups （P〉0.05）. Conclusion Fentanyl,refentanyl and sufentanil are able to used safely in painless enteroscopy, though there is significant difference in the analgetic effect, awaken time, and total propofol. We should choose analgesic drugs reasonably according to the physical condition of patients and the need of the endoscopy.

关 键 词：芬太尼 瑞芬太尼 舒芬太尼 丙泊酚 无痛肠镜检查 

分 类 号：R971.1[医药卫生—药品] R730.49[医药卫生—药学]