MAC技术在老年纤维结肠镜中的应用  

Application of MAC technique in elderly patients with colonoscopy

作　　者：金学勇[1] 梁桂玲[1] 祁燕[2] 余叶[3] 王渭兵 JIN Xueyong;LIANG Guiling;QI Yan;YU Ye;WANG Weibing(Department of Anesthesiology,Korla Hospital of Second Division of Xinjiang Production and Construction Corps,Korla,Xinjiang 841000,China;Department of Respiration,Korla Hospital of Second Division of Xinjiang Production and Construction Corps,Korla,Xinjiang 841000,China;Department of Functions,Korla Hospital of Second Division of Xinjiang Production and Construction Corps,Korla,Xinjiang 841000,China)

机构地区：[1]新疆生产建设兵团第二师库尔勒医院麻醉科,841000 [2]新疆生产建设兵团第二师库尔勒医院呼吸科,841000 [3]新疆生产建设兵团第二师库尔勒医院功能科,841000

出　　处：《新疆医学》2019年第2期131-134,共4页Xinjiang Medical Journal

基　　金：第二师科技计划项目,(项目编号:2016SFGG04)

摘　　要：目的探讨单独瑞芬太尼监测下麻醉管理(monitored anesthesia care, MAC)技术在老年患者结肠镜中的安全性和不良反应。方法选择2016年1月-2017年3月行无痛肠镜老年患者90例,根据随机数表法将其分为三组各30例。B组:缓慢静脉注射丙泊酚(1~2)mg/kg诱导,术中根据患者体动、心率(heart rate, HR)、血压(blood pressure, BP)情况,酌情追加丙泊酚(0.2~0.5)mg/kg。F组:静脉注射芬太尼1ug/kg+B组。R组:静脉泵注瑞芬太尼30ug诱导后,以0.08 ug/kg/min的速度静脉泵注瑞芬太尼,记录三组记录HR、呼吸频率(respiratory rate, RR)、平均动脉压(mean arterial pressure, MAP)和血氧饱和度(oxygen saturation, SpO2)变化情况和不良反应发生情况。记录麻醉相关时间及镇痛评分情况。结果与T0时比较,T1时三组患者MAP均明显降低(P<0.05), T3时HR均明显减慢(P<0.05)。R组诱导时间、苏醒时间、离院时间明显短于B组、F组(P<0.05);VAS镇痛评分高于B组、F组(P<0.05);B组、F组患者体动、注射痛明显高于R组(P<0.05)。结论单独瑞芬太尼MAC技术在老年患者结肠镜的应用,对循环系统影响小,镇痛确切,不良反应少,术后恢复时间短,患者意识清楚等优点提高安全性,能满足老年结肠镜镇痛需要,适用于老年无痛结肠镜检查。Objective To investigate the safety and adverse reactions of monitored anesthesia care(MAC) under remifentanil monitoring alone in colonoscopy for elderly patients. Methods Ninety elderly patients who underwent painless enteroscopy from January 2016 to March 2017 were selected and divided into three groups according to the random number table method. Group B: Induced by slow intravenous injection of propofol 1-2 mg/kg, propofol 0.2-0.5 mg/kg was added as appropriate according to the patient’s heart rate(HR)and blood pressure(BP). Group F: intravenous fentanyl 1 ug/kg+B. Group R: Remifentanil was injected intravenously at a rate of 0.08 ug/kg/min after induction by 30 UG intravenous infusion. HR, respiratory rate(RR), mean arterial pressure(MAP)and oxygen saturation(SpO2)were recorded in three groups. Anesthesia-related time and analgesia score were recorded. Results Compared with T0, MAP decreased significantly at T1(P < 0.05)and HR decreased significantly at T3(P < 0.05). The induction time, recovery time and discharge time of group R were significantly shorter than that of the group B and the group F(P < 0.05); the VAS analgesia score was higher than that of the group B and the group F(P < 0.05); the body movement and injection pain of the group B and the group F were significantly higher than that of the group R(P < 0.05). Conclusion The application of remifentanil MAC alone in colonoscopy of elderly patients has little effect on circulatory system, accurate analgesia, less adverse reactions, and recovery after operation. The advantages of short interval and clear consciousness of patients can improve the safety and meet the needs of analgesia by colonoscopy in the elderly. It is suitable for painless colonoscopy in the elderly.

关 键 词：结肠镜 老年 监测下麻醉管理技术 瑞芬太尼 

分 类 号：R614.24[医药卫生—麻醉学]