全凭瑞芬太尼清醒镇静在老年重症病人消化内镜诊疗中的应用  

Conscious sedation with remifentanil for digestive endoscopy in elderly critical patients

作　　者：李荣荣[1] 曹小飞[1] 丁正年[1] LI Rong-rong;CAO Xiao-fei;DING Zheng-nian(Department of Anesthesiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏省南京市210029

出　　处：《实用老年医学》2020年第12期1275-1278,共4页Practical Geriatrics

摘　　要：目的评价单纯瑞芬太尼清醒镇静在老年重症病人消化内镜诊疗中的临床应用效果。方法选择152例行消化内镜诊疗接受单纯瑞芬太尼清醒镇静的老年重症病人。记录麻醉前(T0)、进镜前即刻(T1)、进镜后2 min(T2)、主要操作刺激时(T3)及术毕时(T4)5个时间点的心率(HR)、平均动脉压(MAP)、SpO2、呼吸频率(RR)及脑电双频指数(BIS)。记录病人的手术完成率、不良反应发生情况,术后随访病人和术者的满意度。结果152例病人全部完成手术。与T0相比,T1时病人的HR、MAP、RR、BIS水平下降,差异均具有统计学意义(P<0.05),T2、T3、T43个时间点HR、MAP、RR、BIS基本恢复稳定,与T0差异均无统计学意义(P>0.05)。各时间点SpO2比较,差异无统计学意义(P>0.05)。病人术中Ramsay镇静评分维持在2~3分。术中呼吸抑制、呛咳、体动的发生率分别为1.3%、0.6%、1.3%。术后随访病人及术者的满意度均为100%。结论全凭瑞芬太尼清醒镇静能够安全有效地用于老年重症病人消化内镜诊疗。Objective To evaluate the conscious sedation effect with remifentanil in the elderly critical patients undergoing digestive endoscopy.Methods A total of 152 elderly critical patients undergoing digestive endoscopy with remifentanil for conscious sedation were enrolled.The values of heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),percutaneous onygen saturation(SpO2)and bispectral index(BIS)were recorded at five time points before anesthesia(T0),full sedation and before endoscopy(T1),2 min after beginning of endoscopy(T2),during endoscopic operation(T3),and at the end of the operation(T4).The intraoperative and postoperative events including completion ratio of operation,Ramsay score,adverse reactions and satisfaction of operators and patients were also recorded.Results All the patients completed the operations.Compared with T0,the levels of HR,MAP,RR and BIS were significantly decreased at T1(P<0.05),but being to stable at T2-T4(P>0.05).There was no significant difference in SpO2 among the time points(P>0.05).The Ramsay score was maintained at 2-3 during the operation.The incidences of respiratory depression,cough response and body movement was 1.3%,0.6%and 1.3%,respectively.The satisfaction degree of operators and patients were both 100%.Conclusions Conscious sedation with remifentanil in the elderly critical patients undergoing digestive endoscopy is safe and effective.

关 键 词：瑞芬太尼 清醒镇静 重症病人 消化内镜诊疗 老年人 

分 类 号：R614.2[医药卫生—麻醉学]