异丙酚在肥胖症患者无痛胃镜中的应用:三种用药方式的比较  

Application of propofol during painless gastroscopy in morbidly obese patients: a comparison of three different anesthetisa methods

作　　者：王效德[1] 潘阳阳 乔南南 徐桂萍[1] 唐冬梅[1] Wang Xiaode;Pan Yangyang;Qiao Nannan;Xu Guiping;Tang Dongmei(The People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,乌鲁木齐830000

出　　处：《中华肥胖与代谢病电子杂志》2018年第2期103-107,共5页Chinese Journal Of Obesity and Metabolic Diseases：Electronic Edition

基　　金：院内科研基金(基金号:20160106)

摘　　要：目的通过比较异丙酚三种用药方式在肥胖症患者的无痛胃镜检查中的镇静效果,探讨异丙酚最佳用药方式。方法回顾性分析2016年3月至2018年5月在新疆维吾尔自治区人民医院行无痛胃肠镜检查的患者90例,年龄18～50岁,体重质量指数(BMI)>35 kg/m^2,ASA分级Ⅰ～Ⅱ级,根据随机数字表法分为三组(n=30),三组患者均给予舒芬太尼0.1μg/kg,A组2 min后给予异丙酚2 mg/kg;B组在给于舒芬太尼的同时给于异丙酚1 mg/kg,2 min后追加1 mg/kg;C组给予舒芬太尼同时使用靶控输注(T_CI)泵维持异丙酚血浆靶浓度(Cpt)2.5μg/mL;三组均待患者入睡且睫毛反射消失后置入鼻咽通气道,由麻醉医师托起患者下颌待呼吸平稳后开始手术;若手术开始时或后续操作中有明显体动则追加异丙酚0.5 mg/kg。记录三组患者麻醉诱导前(T_0)、麻醉诱导后(T_1)、睁眼时(T_2)的心率(HR)。呛咳的例数、明显呼吸抑制的例数、停止操作的例数、Ramsay镇静评分,开始时间(麻醉开始到胃镜操作开始的时间)、睁眼时间、定向力恢复时间、认知力恢复时间和异丙酚用量(mg/kg)。结果 A组和C组T_1时点相较于T_0的HR有统计学差异(P<0.05),B组HR波动差异无统计学意义(P>0.05)。B组相较于A、C两组呼吸抑制发生率明显较低(P<0.05);A组相较于B、C两组术中呛咳和停止操作的发生率明显较高(P<0.05);A组相较于B、C两组术中Ramsay镇静评分明显较低(P<0.05); B组相较于A组和C组的开始时间(min)、睁眼时间(min)、定向力恢复时间(min)、认知恢复时间(min)明显较短(P<0.05);B组相较于A组和C组用药量明显减少(P<0.05)。结论肥胖症患者的无痛胃镜检查中最佳的麻醉用药方式为分次给药。Objective By comparing the sedative eff ects of three anesthetisa methods of propofol on painless gastroscopy in morbidly obese patients to explore the optimal administration method of propofol.Methods 90 patients with painless gastroscopy in the People's Hospital of Xinjiang Uygur Autonomous Region,aged 18 to 50 years,with BMI over 35 kg/m2,and ASA class I to II.They were randomly divided into three groups according the digital table method,with 30 patients in each group.At fi rst,all the three groups of patients were given 0.1μg/kg Sufentanil;in group A,2 mg/kg propofol was injected after 2 minutes.In the group B,1mg/kg propofol was given during at the same time as sufentanil,and the addition of 1 mg/kg propofol after 2min.In the group C,propofol was injected to maintain the plasma concentration at Cpt 2.5μg/mL by TCI during giving sufentanil.All three groups were inserted nasopharyngeal airway after the patient fell asleep and the refl exes of the eyelashes disappeared.The anesthesiologist lifted the patient's lower jaw and operation began after patients breathed smoothly.If there is obvious body movement during operation,additional 0.5 mg/kg propofol would be added to enhance and maintain anesthesia.The heart rate(HR)of the three groups before the induction of anesthesia(T0),after the induction of anesthesia(T1),and at the time of the blink(T2)were recorded.We observed the numbers of coughing,signifi cant respiratory depression and stopping operations;the Ramsay sedation score,time to start operation;time of opening their eyes,recovering orientation and recovering cognition,and propofol dosage(mg/kg).Results There was a statistically signifi cant diff erence in HR between T1 and T0 in group A and group C(P<0.05),but there was no signifi cant diff erence in HR fl uctuations in group B(P>0.05).The incidence of respiratory depression was signifi cantly lower in group B than in group A and C(P<0.05).Compared with group B and C,the incidence of cough and cessation during operation was significantly higher in gro

关 键 词：异丙酚 无痛胃镜 用药方式 

分 类 号：R614[医药卫生—麻醉学]