异丙酚-芬太尼与咪达唑仑-芬太尼用于晚期肝病胃肠内镜检查安全性比较  

Comparison of safety between propofol fentanyl and midazolam fentanyl for gastrointestinal endoscopy in advanced liver diseases

作　　者：刘婷婷[1] 解东明 邓友明 LIU Ting-ting;XIE Dong-ming;DENG You-ming(Department of Anesthesiology,the Second Hospital of Nanjing City,Nanjing Hospital Affilated to Nanjing University of Traditional Chinese Medicine,Jiangsu Province,Nanjing 210000,China)

机构地区：[1]南京中医药大学附属南京医院,南京市第二医院麻醉科,江苏南京210000

出　　处：《河北医科大学学报》2023年第6期707-712,共6页Journal of Hebei Medical University

基　　金：江苏省自然科学基金面上项目(BK20181145)。

摘　　要：目的比较异丙酚-芬太尼与咪达唑仑-芬太尼用于晚期肝病患者胃肠内镜检查的安全性。方法招募因肝硬化接受胃肠内镜检查的晚期肝病患者86例。所有患者均进行上消化道内镜检查,根据麻醉用药方案将患者分为异丙酚-芬太尼组和咪达唑仑-芬太尼组,每组43例。异丙酚-芬太尼组给予静脉注射异丙酚2 mg/kg和芬太尼0.5μg/kg。咪达唑仑-芬太尼组给予静脉注射咪达唑仑3 mg和芬太尼0.5μg/kg。比较诱导前(T0)、镇静后5 min(T1)、镇静后10 min(T2)、镇静后15 min(T3),镇静后30 min(T4)、手术结束前5 min(T5)血流动力学参数[血氧饱和度(oxygen saturation,SpO_(2))、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)]变化。比较T0~T5时点Ramsay镇静评分。比较术前、麻醉诱导、气管插管和术后的脑电图双谱指数(bispectral index,BIS)值、脑电图θ波和δ波波段频率。比较受试者手术期间不良反应发生情况。结果2组SpO_(2)水平呈逐渐升高趋势,HR水平呈逐渐降低趋势,异丙酚-芬太尼组SpO_(2)水平升高幅度大于咪达唑仑-芬太尼组,HR水平降低幅度大于咪达唑仑-芬太尼组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组Ramsay镇静评分、脑电图δ波波段均呈先升高再降低趋势,BIS和脑电图θ波波段呈先降低再升高趋势,异丙酚-芬太尼组Ramsay镇静评分、BIS、脑电图θ波波段、脑电图δ波波段波动幅度大于咪达唑仑-芬太尼组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。异丙酚-芬太尼组低血压发生率高于咪达唑仑-芬太尼组(P<0.05)。结论异丙酚或咪达唑仑与芬太尼联合使用对上消化道内窥镜检查的晚期肝病患者的镇静作用是有效的,与咪达唑仑相比,异丙酚药物能更好的发挥深度镇静作用,体现在BIS降低和脑电图δ波段频率升高,然而会增加低血压的发生风险。Objective To compare the safety of propofol fentanyl and midazolam fentanyl for gastrointestinal endoscopy in patients with advanced liver disease.Methods A total of 86 patients with advanced liver disease who underwent gastrointestinal endoscopy due to cirrhosis were recruited.All patients underwent upper gastrointestinal endoscopy examination.Patients were divided into propofol fentanyl group(n=43)and midazolam fentanyl group(n=43),according to the anesthesia medications.The propofol fentanyl group received intravenous propofol 2 mg/kg and fentanyl 0.5μg/kg,while the midazolam fentanyl group received intravenous midazolam 3 mg and fentanyl 0.5μg/kg.Changes in hemodynamic parameters[oxygen saturation(SpO_(2)),heart rate(HR),mean arterial pressure(MAP)]before induction(T0),at 5 min after sedation(T1),10 min after sedation(T2),15 min after sedation(T3),30 min after sedation(T4),and at 5 min before surgery(T5).The Ramsay sedation scores at T0 to T5 were compared.The bispectral index(BIS)values,and postoperative electroencephalogram(EEG)θwave andδwave band frequency before surgery,before anesthesia induction,before tracheal intubation and after surgery were compared.The occurrence of adverse reactions during surgery among the subjects was compared.Results The SpO_(2) levels in the two groups showed a gradual upward trend,while the HR levels showed a gradual downward trend.The increase in SpO_(2) levels in the propofol fentanyl group was greater than that in the midazolam fentanyl group,while the decrease in HR level was greater than that in the midazolam fentanyl group.There were statistically significant difference in the interaction between groups,time points,and time points between groups(P<0.05).The Ramsay sedation scores and EEGδwave band showed a trend of initial increasing and then decreasing in the two groups,while BIS and EEGθwave band showed a trend of initial decreasing and then increasing.The Ramsay sedation score,BIS,and fluctuation amplitude of EEGθwave band,EEGδwave band were greater in the pr

关 键 词：终末期肝病 内窥镜检查 异丙酚 咪达唑仑 

分 类 号：R575.3[医药卫生—消化系统]