纳布啡复合丙泊酚在无痛胃镜检查麻醉中神经功能及安全性评价  

Neurological Function and Safety of Nalbuphine Combined with Propofol in Painless Gastroscopy Anesthesia: A Randomized,Double-blind,Large-sample,Multicenter Clinical Study

作　　者：杨川[1] 贾绍茂 何丽云[1] 陈贤华[1] 谭首鹏[1] 柴天波 王义[3] 王茜[4] 付雄[5] 何琼珍[6] 赵泽宇 Yang Chuan;Jia Shaomao;He Liyun(Department of Anesthesiology,Guangyuan Second People′s Hospital,Guangyuan,Sichuan 628012 China)

机构地区：[1]广元市第二人民医院麻醉科,四川广元628017 [2]广元市朝天区人民医院麻醉科,四川广元628012 [3]广元市第一人民医院麻醉科,四川广元628017 [4]广元市中心医院麻醉科,四川广元628000 [5]广元市第三人民医院麻醉科,四川广元628017 [6]广元市第四人民医院麻醉科,四川广元628017 [7]四川省八一康复中心麻醉科,四川成都611135

出　　处：《四川医学》2019年第1期11-17,共7页Sichuan Medical Journal

基　　金：四川省卫生计生委课题(编号:18PJ184)

摘　　要：目的评价纳布啡复合丙泊酚在无痛胃镜检查麻醉中的安全性和对神经功能的影响。方法选择拟行无痛胃镜检查的患者1000例,其中男553例,女447例,年龄18～64岁,体质量40～75kg,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。按随机数字表法分为芬太尼组(F组)、瑞芬太尼组(R组)、舒芬太尼组(S组)、纳布啡组(N组)及对照组(C组),每组200例。所有药物配制成10mL并编号:(1)号芬太尼8μg/m L,(2)号舒芬术尼0. 8μg/m L,(3)号瑞芬太尼5μg/m L,(4)号纳布啡1mg/m L,(5)号生理盐水10mL。监测并记录左侧卧位后(T0)、镇痛药推注完毕(T1)、丙泊酚推注完毕(T2)、胃镜置入即刻(T3)、胃镜置入十二指肠(T4)、胃镜检查结束(T5)、苏醒后(T6)患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸频率(RR)及脉搏血氧饱和度(SPO_2);记录麻醉起效时间、胃镜检查时间、苏醒时间、离院时间;评价手术医师满意度;记录患者术中SPO_2<90%、呼吸暂停、心动过缓或过速以及术后便秘、疼痛、恶心呕吐、尿潴留、术中知晓等并发症的发生情况;采用简易智能精神状态检查量表(MMSE)评价患者离院时(T7)、术后24h(T8)、术后72h(T9)神经功能。结果5组不同时间点SBP、DBP、HR存在差别(P<0. 05),与T0比较,5组SBP、DBP在T2～T5均降低,F组、S组、R组及C组HR、RR在T2～T5均降低(P<0. 05)。5组患者在苏醒时间、离院时间及丙泊酚用量上差异有统计学意义(P<0. 01),与C组比较,F组、S组R组及N组麻醉苏醒时间、离院时间及丙泊酚用量显著降低(P<0. 01)。与N组比较,F组、S组、R组及C组医师满意度降低(P<0. 01);与C组比较,F组、S组、R组满意度增加(P<0. 05或<0. 01);与F组比较,R组满意度降低(P<0. 01)。与N组比较,R组SPO_2<90%、呼吸暂停、心动过缓或过速等并发症发生率增加,C组SPO_2<90%、呼吸暂停等发生率增加(P<0. 01);与C组比较,F组、S组、R组、N组患者术后疼痛发生率下降(P<0. 0Objective To evaluate the safety and neurological function of nalbuphine combined with propofol in painless gastroscopy anesthesia.Methods A total of one thousand patients with 553 males and 447 females,aged 18-64 years old,weighing 40-75 kg,ASA physical status I or II,scheduled for painless gastroscopy,were randomly allocated into 5 groups according random number table method:fentanyl group(group F),remifentanil group(group R),sufentanil group(group S),nalbuphine group(group N)and control group(group C),each group of 200 cases.The drug was prepared into 10mL and numbered:No.1 fentanyl 8μg/mL,No.2 sufentanil 0.8μg/mL,No.3 remifentanil 5μg/mL,No.4 nalbuphine 1mg/mL and No.5 saline 10mL.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),respiratory rate(R)and pulse oxygen saturation(SPO 2)were recorded after left supine position(T0),analgesic injection(T1),propofol injection(T2),gastroscopy immediately(T3),gastroscopy into duodenum(T4),gastroscopy examination(T5)and recovery(T6).The onset time of anesthesia,the time of gastroscopy,the time of recovery and the time of leaving hospital were recorded.The satisfaction of surgeons was evaluated.The incidence of SPO 2﹤90%,apnea,bradycardia or tachycardia,postoperative pain,nausea and vomiting,urinary retention and intraoperative awareness were recorded.Neurological function was assessed by Mini Mental State Examination(MMSE)at the time of discharge(T7),24 hours(T8)and 72 hours(T9)after operation.Results There were differences in SBP,DBP and HR at different time points between the 5 groups(P﹤0.05).Compared with T0,SBP and DBP in five groups were decreased in T2~T5,HR and RR in group F,group S,group R and group C were all decreased in T2~T5(P﹤0.05).There were significant differences in recovery time,discharge time and propofol dosage among the five groups(P﹤0.01).Compared with group C,the recovery time,discharge time and propofol dosage in group F,group S,group R and group N were significantly decreased(P﹤0.01).Compared with group N,the

关 键 词：纳布啡 二异丙酚 胃镜检查 认知 随机对照试验 

分 类 号：R614.2[医药卫生—麻醉学]