丙泊酚在不同Child-Pugh分级肝硬化患者无痛胃肠镜检查中的麻醉效果及不良反应分析  

Anesthetic effect and adverse reactions of propofol in painless gastrointestinal endoscopy in patients with different Child-Pugh classification of liver cirrhosis

作　　者：高放 常越 李海[1] GAO Fang;CHANG Yue;LI Hai(Department of Hepatopancreatobiliary and Splenic Medicine,The Affiliated Hospital of Logistics University of Chinese People＇s Armed Police Forces,Tianjin 300162,China)

机构地区：[1]中国人民武装警察部队后勤学院附属医院肝胆胰脾科,天津300162

出　　处：《临床肝胆病杂志》2018年第7期1440-1444,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金项目(81173393);武警后勤学院创新团队基金项目(WHTD201310)

摘　　要：目的观察丙泊酚在不同肝硬化患者无痛胃肠镜检查中的麻醉效果及不良反应分析。方法收集2015年2月-2017年8月于中国人民武装警察部队后勤学院附属医院接受丙泊酚麻醉的胃肠镜检查肝硬化患者342例。根据术前Child-Pugh分级,将患者分为Child-Pugh A组(n=224)、Child-Pugh B组(n=94)、Child-Pugh C组(n=24)。比较3组患者麻醉效果和不良反应情况。计量资料多组间比较采用方差分析,进一步两两比较使用SNK-q检验比较;计数资料组间比较使用χ~2检验或KruskalWallis H秩和检验,进一步两两比较采用Ridit分析。结果患者肝功能越差麻醉剂总用量越少,3组差异有统计学意义(F=4.401,P=0.017),肝功能越差意识消失时间越短,Child-Pugh C组患者意识消失时间短于Child-Pugh A、B组,3组差异具有统计学意义(F=9.440,P=0.001)。3组均未出现丙泊酚过敏、丙泊酚输注综合征、惊厥样反应等不良反应。3组患者麻醉期间注射部位疼痛、心律失常、呼吸抑制发生差异均无统计学意义(P值均>0.05)。患者血压下降发生情况3组差异具有统计学意义(H=3.795,P<0.001),其中Child-Pugh B组较Child-Pugh A、C组低(P值均<0.05)。结论丙泊酚在不同肝硬化患者无痛胃肠镜检查中的麻醉效果安全,未见严重药物不良反应,患者肝功能越差丙泊酚用量越少,术中应密切关注患者血压变化。Objective To investigate the anesthetic effect and adverse reactions of propofol in painless gastrointestinal endoscopy in patients with varying degrees of liver cirrhosis. Methods A total of 342 patients with liver cirrhosis who underwent gastrointestinal endoscopy under propofol anesthesia in The Affiliated Hospital of Logistics University of Chinese People＇s Armed Police Forces from February 2015 to August2017 were enrolled. According to the Child-Pugh class before surgery,the patients were divided into Child-Pugh A Group（ n = 224）,Child-Pugh B group（ n = 94）,and Child-Pugh C Group（ n = 24）. The three groups were compared in terms of anesthetic effect and adverse reactions. An analysis of variance was used for comparison of continuous data between multiple groups,and the SNK-q test was used for further comparison between any two groups; the chi-square test or the Kruskal-Wallis H rank sum test was used for comparison of categorical data between multiple groups,and a Ridit analysis was used for further comparison between any two groups. Results Compared with the Child-Pugh A group and the Child-Pugh B group,the Child-Pugh C group had a significantly smaller amount of propofol used（ F =4. 401,P = 0. 017） and a significantly shorter time of loss of consciousness（ F = 9. 440,P = 0. 001）. No patient experienced adverse reactions such as allergy to propofol,propofol infusion syndrome,and convulsion-like reactions. There were no significant differences in the incidence rates of pain at the injection site,arrhythmia,and respiratory depression between the three groups（ all P〉0. 05）. There was a significant difference in the reduction in blood pressure between the three groups（ H = 3. 795,P〈0. 001）,and the Child-Pugh B group had significantly lower blood pressure than the other two groups（ both P〈0. 05）. Conclusion Propofol has a safe anesthetic effect in painless gastrointestinal endoscopy in patients with varying degrees of liver cirrhosis and does not have serious adverse effec

关 键 词：肝硬化 二异丙酚 胃镜检查 麻醉 静脉 

分 类 号：R575.2[医药卫生—消化系统] R614[医药卫生—内科学]