曲马多复合丙泊酚在无痛肠镜检查中的应用及对应激反应和膈肌运动影响的研究  

The Application of Tramadol Combined with Propofol in Painless Colonoscopy and Its Influence on Stress Response and Diaphragm Movement

作　　者：林志远 翁嘉全 林昕 LIN Zhiyuan;WENG Jiaquan;LIN Xin(Department of Anesthesiology,The Second Affiliated Hospital of Shantou University Medical College,Shantou,Guangdong 515000,China)

机构地区：[1]汕头大学医学院第二附属医院麻醉二科,广东汕头515000

出　　处：《转化医学杂志》2024年第5期787-791,共5页Translational Medicine Journal

基　　金：汕头市科技计划医疗卫生类别(210624106490663)。

摘　　要：目的探讨曲马多复合丙泊酚在无痛肠镜检查中的应用效果,并研究其对应激反应指标和膈肌运动的影响。方法选取120例接受无痛肠镜检查的患者,随机分为A组和B组,每组60例。A组给予芬太尼联合丙泊酚麻醉,B组给予曲马多复合丙泊酚静脉麻醉。对比2组围检查期应激指标[皮质醇(Cor)、血管紧张素Ⅱ(Ang-Ⅱ)],膈肌运动指标[膈肌运动幅度(DM)、膈肌厚度变化率(DTF)]、麻醉起效时间、操作时间以及麻醉药物使用情况。记录检查中不良事件的发生情况,同时使用Richmond躁动-镇静量表(RASS)评估患者的围检查期镇静情况。结果麻醉后10、20 min,A、B 2组RASS评分差异无统计学意义(P>0.05);术毕20、60 min,B组的RASS得分高于A组(P<0.05)。麻醉后5 min、术毕5 min,B组血清Cor、Ang-Ⅱ均低于A组(P<0.05)。麻醉后5、10 min,B组的DM均大于A组(P<0.05);麻醉后5、10 min和术毕,B组DTF均大于A组(P<0.05)。A组麻醉起效时间短于对照组(P<0.05),2组的肠镜操作时间、丙泊酚使用总量以及丙泊酚追加次数差异均无统计学意义(P>0.05)。B组术中不良事件总发生率低于A组(5.00%vs 16.67%)。结论芬太尼、曲马多分别联合丙泊酚均能满足无痛肠镜检查的静脉麻醉需求。但相较于芬太尼联合丙泊酚麻醉,曲马多复合丙泊酚方案能够有效减轻患者术中应激反应和对膈肌运动的影响,可降低术中不良事件的发生风险,由此可见曲马多与丙泊酚联用可能是一种有前景的无痛结肠镜检查麻醉方案。Objective To evaluate the application of tramadol combined with propofol in painless colonoscopy and its effects on stress response indicators and diaphragm movement.Methods A total of 120 patients receiving painless colonoscopy were randomly separated into group A and group B(60/group).Group A received fentanyl and propofol anesthesia,while group B received tramadol and propofol intravenous anesthesia.The stress indexes[cortisol(Cor),angiotensinⅡ(Ang-Ⅱ)],diaphragm movement indexes[diaphragm motion degree(DM),diaphragm thickening fraction(DTF)],anesthesia onset time,operation time,and narcotic drug use were compared between the two groups.The occurrence of adverse events during the examination was recorded,and peri-examination sedation was assessed using the Richmond Agitation and Sedation Scale(RASS).Results There were no differences in RASS scores between group A and group B 10 and 20 minutes after anesthesia(P>0.05);RASS scores in group B were higher than those in group A 20 and 60 minutes after the operation(P<0.05).Serum Cor and Ang-Ⅱin group B were lower than those in group A 5 minutes after anesthesia and 5 minutes after surgery(P<0.05).DM in group B was higher than that in group A 5 and 10 minutes after anesthesia(P<0.05);DTF in group B was higher than that in group A 5 and 10 minutes after anesthesia and after surgery(P<0.05).The onset time of anesthesia in group A was shorter than that in group B(P<0.05),and there were no differences in colonoscopy operation time,total propofol usage,or the number of additional propofol doses between the two groups(P>0.05).The incidence of adverse events in group B was significantly lower than in group A(5.00%vs 16.67%).Conclusion Fentanyl and tramadol combined with propofol can meet the intravenous anesthesia requirements of painless colonoscopy.However,compared with fentanyl combined with propofol,the tramadol combined with propofol regimen can effectively reduce the stress response during surgery,minimize the impact on diaphragm movement,and reduce the risk of

关 键 词：曲马多 丙泊酚 无痛肠镜检查 应激反应 膈肌运动 

分 类 号：R614[医药卫生—麻醉学]