不同年龄对纤维结肠镜检查术患者复合低剂量芬太尼麻醉时丙泊酚药效学的影响  

Effect of patients age on propofols pharmacodynamics while combining with low dose fentanyl in colonoscopy

作　　者：谢文钦[1] 李扬亿[1] 谢文吉[1] 颜景佳[1] 江长城[1] 康振明[1] 

机构地区：[1]福建医科大学附属泉州市第一医院麻醉科,362000

出　　处：《临床麻醉学杂志》2014年第5期462-465,共4页Journal of Clinical Anesthesiology

基　　金：福建省泉州市科学委员会资助课题

摘　　要：目的探讨不同年龄对纤维结肠镜检查术患者复合低剂量芬太尼麻醉时丙泊酚药效学的影响。方法选择ASAⅠ或Ⅱ级纤维结肠镜检查术患者90例，按不同年龄分为：A组（18～39岁）、B组（40-64岁）和C组（65-89岁），每组30例。A组、B组和C组初始丙泊酚效应室靶浓度分别为2．5、2．0、1．5ug／ml，血浆浓度和效应室浓度达到平衡后，静注芬太尼1.0μg／kg。记录麻醉诱导前（T0）、检查开始即刻（T1）、结肠镜至乙状结肠（T2）、回盲瓣（T3）、体动前（T4）、体动后（T5）、检查结束时（T6）的MBP、HR、SpO2和体动前后听觉诱发电位指数（AAI），计算半数有效效应室浓度（EC50）和半数有效听觉诱发电位指数（AAI50）。记录术后恶心、呕吐、嗜睡等不良反应。结果A组E岛为4．36（95％CI4．05～4．66）ug／ml、B组EC5（13．54（95％CI3．19～3．88）μg／ml、C组EC50 2．79（95％CI2．45～3．11）μg／ml，呈递减趋势（P〈0．05）；A组AA50 22．13（95％CI 18．54～24．80）、B组AAI50 24．95（95％CI20．26～28．85），明显小于C组AAk29．72（95％CI27．79～33．67）（P〈0．05）。纤维结肠镜插入三组阳性反应的AAI大于阴性反应者（P〈0．01）；体动前的AAI明显小于体动后（P〈0．01）。A组、B组分别O、2例出现短暂性低血压，明显低于C组8例患者（P〈0．05），其中C组3例患者的低血压通过输液和降低丙泊酚目标浓度而升高，其余7例未给予任何治疗，插入纤维结肠镜后血压恢复正常。A组、B组分别有1例、3例插入纤维结肠镜后出现呼吸抑制（SpO2〈90％），分别低于C组的8例（P〈0．05），患者给予开放气道后SpO2自行恢复正常。结论对纤维结肠镜检查术患者，年龄是影响丙泊酚药效学的重要因素。Objective To determine the EC50 and AAI50 of propofol in plasma combined with fentanyl 1μg/kg in colonoscopy of different age group. Methods Ninety patients of ASA status I or ]][ undergoing painless colonoscopy were divided into three groups（n= 30） by age, which initial effect-site concentrations of propofol were 2. 5, 2.0, 1.5 μg/ml. After the target concentrations of plasma and effect-site of propofol were balanced, fentanyl 1.0 μg/kg was infused. MAP, HR, SpO2 and AAI were recorded every minute. MAP, HR, SpO2 and AAI at the time point before induction （T0）, when insert colonoscope（T1 ）, while colonoscope arrived at sigmoid colon（T2 ） and ileocecal valves（T3）, before body movement（T4）, after body movement（T5）, when colonoscopy finished （T6） were recorded. The EC50 and AAI50 of propofol combined with fentany were measured. Results The EC50 value and it＇s 95% confidence interval of propofol in 3 groups were： 4.36（4.05-4. 66）, 3.54 （3.19-3.88）and 2.79（2.45-3.11）μg/ml. AAIs0 of these three groups were 22.13（18. 54 24.80）, 24.95（20. 26-28.85）, 29.72（27.79-33.67） （P〈0.05）. The ratios of reaction to spoken commands were 0, 0, 20% （P〈0.05）. In three groups the numbers of patients who occurred low blood pressure were 0,2, 8（P〈0. 05）, and respiratory depression were 1,3,8（P〈0.05）. Conclusion Age was an important element to the pharmacodynamics of propofol while patients received propofol combined with fentanyl 1μg/kg undergoing colonoscopy.

关 键 词：年龄 芬太尼 丙泊酚 靶控输注 半数有效效应室浓度 听觉诱发电位 纤维结肠镜检查术 

分 类 号：R614[医药卫生—麻醉学]