丙泊酚在克罗恩病患者无痛胃肠镜检查中的半数有效剂量  

Median effective does of propofol for painless gastrointestinal endoscopy in patients with Crohn's disease

作　　者：刘婷婷 刘存明[2] LIU Tingting;LIU Cunming(The First Clinical Medical College of Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学第一临床医学院,211166 [2]南京医科大学第一附属医院麻醉科

出　　处：《临床麻醉学杂志》2023年第6期577-581,共5页Journal of Clinical Anesthesiology

摘　　要：目的采用序贯法测定丙泊酚在克罗恩病患者无痛胃肠镜检查中的半数有效剂量(ED_(50))。方法选择克罗恩病患者24例(D组)和正常体检患者23例(C组),男23例,女24例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅠ或Ⅱ级。常规行HR、BP、SpO_(2)和BIS监测,静脉推注丙泊酚行无痛胃肠镜检查。根据序贯法确定D组丙泊酚初始剂量2.2 mg/kg,C组初始剂量2.4 mg/kg。当BIS为60时进镜,若出现阳性反应,则下一例剂量增加0.2 mg/kg,否则减少0.2 mg/kg。阳性反应定义为麻醉诱导后患者BIS无法降至60,或入镜时出现呛咳或体动反应2级及以上。记录既往行无痛胃肠镜和全麻次数以及低血压和呼吸抑制的发生情况。采用概率回归分析法计算两组的ED_(50)、ED_(95)和95%可信区间(CI),比较两组ED_(50)和ED_(95)。结果与C组比较,D组既往行无痛胃肠镜和全麻的次数明显增多(P<0.05)。D组使用丙泊酚行无痛胃肠镜检查的ED_(50)为2.80 mg/kg(95%CI 2.72~2.88 mg/kg),ED_(95)为3.20 mg/kg(95%CI 3.12~3.32 mg/kg),C组使用丙泊酚行无痛胃肠镜检查的ED_(50)为2.42 mg/kg(95%CI 2.38~2.46 mg/kg),ED_(95)为2.60 mg/kg(95%CI 2.51~2.70 mg/kg)。D组使用丙泊酚行无痛胃肠镜检查的ED_(50)、ED_(95)明显高于C组(P<0.05)。两组低血压和呼吸抑制发生情况差异无统计学意义。结论丙泊酚在克罗恩病患者行无痛胃肠镜检查中的ED_(50)为2.80 mg/kg(95%CI 2.72~2.88 mg/kg),体检患者的ED_(50)为2.42 mg/kg(95%CI 2.38~2.46 mg/kg)。克罗恩病患者可能因曾反复多次行丙泊酚麻醉导致其使用丙泊酚行无痛胃肠镜的用药量高于体检患者,需要增加丙泊酚用量才能满足临床镇静需求。Objective The median effective dose(ED_(50))of patients with Crohn's disease using propofol for painless gastrointestinal endoscopy is determined by sequential method.Methods Twenty-four patients with Crohn's disease(group D)and twenty-three healthy physical examination patients(group C),23 males and 24 females,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅠorⅡwere selected.HR,BP,SpO_(2),and BIS were monitored.Propofol was injected intravenously for painless gastro-intestinal endoscopy.According to the sequential method,the initial dose of group D was 2.2 mg/kg,and the initial dose of group C was 2.4 mg/kg.When BIS reached 60,endoscopy was started.If a positive reaction was appeared in the patient,the dose of the next patient increased by 0.2 mg/kg,otherwise it decreased by 0.2 mg/kg.If the patient s BIS cannot be reduced to 60 after anesthesia induction,or the cough or body movement reaction occured at level 2 or above when entering the mirror,it was defined as positive recation.The frequency of painless gastroenteroscopy and general anesthesia before operation,as well as the incidence of hypotension and respiratory depression were recorded.The ED_(50),95%effective dose(ED_(95))and 95%confidence interval(CI)of the two groups were calculated by probability regression analysis.Results Compared with group C,the number of painless gastrointestinal endoscopy and general anesthesia in group D was significantly increased(P<0.05).The ED_(50)of propofol for painless gastrointestinal endoscopy in group D was 2.80 mg/kg(95%CI 2.72-2.88 mg/kg)and the ED_(95) was 3.20 mg/kg(95%CI 3.12-3.32 mg/kg).The ED_(50)of propofol for painless gastrointestinal endoscopy in group C was 2.42 mg/kg(95%CI 2.38-2.46 mg/kg).The ED_(95) was 2.60 mg/kg(95%CI 2.51-2.70 mg/kg).The ED_(50)and ED_(95) of propofol for painless gastrointestinal endoscopy in group D was significantly higher than that in group C(P<0.05).There were no significant differences in hypotension and respiratory depression between the two groups.Conclusion The ED_

关 键 词：克罗恩病 体检 丙泊酚 无痛胃肠镜 半数有效剂量 

分 类 号：R614[医药卫生—麻醉学]