丙泊酚复合阿片类药物在胃镜检查中的应用  

Comparison between propofol used alone and in combination with opioids for sedation during gastroscopy

作　　者：夏江燕[1] 陆新健[1] 袁静[1] 谢珏[1] 尹宁[1] 

机构地区：[1]东南大学附属中大医院麻醉科,南京市210009

出　　处：《临床麻醉学杂志》2016年第5期464-467,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨丙泊酚复合阿片类药物与单纯丙泊酚维持用于胃镜检查时的临床效果。方法选择2015年4月在本院行胃镜检查患者285例,男105例,女180例,年龄18~65岁,体重40~90kg,ASAⅠ或Ⅱ级。按随机数字表法分为四组：地佐辛复合丙泊酚组（D组,n=76）、芬太尼复合丙泊酚组（F组,n=87）、羟考酮复合丙泊酚组（O组,n=71）和单丙泊酚组（C组,n=51）。D组静脉注射地佐辛2.0~2.5mg后推注丙泊酚至受检者入睡、睫毛反射消失后开始行胃镜检查;F组静脉注射芬太尼40~50μg、O组静脉注射羟考酮2.0~2.5mg、C组静脉注射与其余三组相同容量的生理盐水,余同D组。记录患者入镜前（T_0）、入镜后1min（T1）、3min（T_2）、5min（T_3）的SBP、DBP、HR、SpO_2。记录患者入镜时及入镜5min内呛咳、体动、追加丙泊酚情况、呼唤睁眼时长及胃镜检查时长。结果 T_1和T_2时D组、T_2时O组、T_2和T_3时F组SBP明显低于C组（P〈0.05）,T_1~T_3时F组DBP明显低于C组（P〈0.05）,T_1~T_3时D、O、F组HR明显慢于C组（P〈0.05）;D、O、F组丙泊酚消耗剂量、每公斤体重丙泊酚消耗剂量均明显低于C组（P〈0.05）,呼唤睁眼时长明显短于C组（P〈0.05）,其中以D组呼唤睁眼时长最短,O组每公斤体重丙泊酚消耗剂量明显高于D组（P〈0.05）,四组胃镜检查时长差异无统计学意义;入镜时及入镜5min内D、O、F组需追加丙泊酚例数、发生体动例数及呛咳例数均明显少于C组（P〈0.01）。结论以丙泊酚复合阿片类药物行无痛胃镜检查有助于减轻丙泊酚单独应用引起的不良反应,降低丙泊酚使用剂量,缩短呼唤睁眼时间。与丙泊酚复合芬太尼或羟考酮比较,丙泊酚复合地佐辛为无痛胃镜检查时的更佳麻醉方案。Objective To study the effects of propofol used alone and in combined with opioids in gastroscopy,in order to select the more suitable anesthesiaprotocol.Methods A total of 285 patients undergoing gastroscopy were selected in April,2015 in our hospital,including 105 males,180females,ranging from 18 to 65years old,weighing 40-90 kg,falling the category of ASA Ⅰ orⅡ.According to random number table,subjects were divided into four groups：dezocine group（group D,n=76）,fentanyl group（group F,n=87）,oxycodone group（group O,n=71）and control group（group C,n=51）.Each group was implemented the corresponding anesthesia.SBP,DBP,HR,SpO_2 in baseline（T_0）,1（T_1）,3（T_2）,5（T_3）min after entering gastroscope were recorded.Choking cough,body movement,extra propofol,awakening time and inspecting time were observed.Results Among four groups,there was no statistical significance in age,gender,weight,blood pressure,heart rate and oxygen saturation and other general information.There were more cases given extra propofol in group C than in the other three groups（P〈0.01）.While for the experimental groups,there were more cases needing extra propofol in group O than in group D and group F（P〈0.01）.The incidences of body movement and choking cough in group C were higher than those in the other three groups（P〈0.01）.Compared with the group C,dosage of propofol,awakening time in the three groups,especially in group D,were much lower（P〈0.01）.Conclusion Propofol in combination with opioids for sedation during painless gastroscopy can alleviate adverse reaction caused by propofol used alone.The more suitable anesthesia protocol is propofol with dezocine.

关 键 词：丙泊酚 地佐辛 芬太尼 羟考酮 胃镜 

分 类 号：R614[医药卫生—麻醉学]