丙泊酚复合小剂量舒芬太尼用于无痛胃镜临床观察

Clinical Analysis of Gastrofiberscopy Preformed with Propofol-sufentanyl

目的探讨丙泊酚复合舒芬太尼用于门诊无痛胃镜的安全性和有效性。方法ASAⅠ-Ⅱ级要求行门诊无痛胃镜检查的患者120例,随机分为3组,即分为丙泊酚+生理盐水组(P组)、丙泊酚复合芬太尼组(PF组)和丙泊酚复合舒芬太尼组(PS组),每组40例。各组在静脉注射丙泊酚前分别静脉注射生理盐水2ml、芬太尼0.5mg、舒芬太尼0.1μg/kg,待患者睫毛反射消失后插入胃镜,检查过程中连续监测HR、MAP、SpO2,记录丙泊酚的总量、意识恢复时间、定向力恢复时间、胃镜操作时间、术中知晓发生率等,观察注药时静脉疼痛、胃镜检查中呛咳、体动反应、头晕的情况。结果三组患者术中HR、MAP、SpO2与术前或术后相比均明显降低(P<0.05),各组之间HR、MAP、SpO2比较差异均有统计学意义(P<0.05),意识恢复时间、定向力恢复时间P组与PF、PS组相比明显延长,差异具有统计学意义(P<0.05),PF、PS组之间也有统计学意义(P<0.05)。丙泊酚用量P组比PF、PS组增加,差异具有统计学意义(P<0.05),PF、PS组之间无统计学差异。结论丙泊酚复合小剂量舒芬太尼(0.1μg/kg)不仅可以减少丙泊酚用量、有效降低呼吸抑制等副反应,而且能缩短苏醒时间,使麻醉更加平稳。

Objective To evaluate efficacy and safety of propofol-sufentanyl applied to anesthesia of gastrofiberscopy. Methods One hundred and twenty patients scheduled for elective gastrofiberscopy were randomized into three groups. Group P （n=40） was given intravenous normal saline （2 ml） before administration of propofol, Group PF （n=40） given intravenous fentanyl （0.5mg） and then propofol, and Group PS （n=40） given intravenous sufentanyl （0.1 μg/kg） and then propofol. Gastrofiberscopy was inserted after eyelashes reflex had been extinct. The parameters, such as HR, MAP, SpO2, total dose of propofol, recovering time of consciousness and orientation, and awareness time during operation, were recorded. Pain from the injection of propofol, cough and body-movement occurrence in the operation were observed. Results MAP, HR and SpO2 were obviously lower in operation than in preoperation or postoperation in each group （P〈0.05） and were of significant difference among all the groups （P〈0.05）. The recovering time of consciousness and orientation was significantly longer in Group P than in Group PF or PS, and there was significantly difference between Group PF and Group PS （P〈0.05）. Total dose of propofol in Group P was significantly larger than that in Group PF or PS （P〈0.05）. Conclusion The combination of propofol with sufentanyl applied to the operation of gastrofiberscopy can provide satisfactory anesthesia effects with advantage of lower dose of propofol, less respiratory depression and rapid recovery after operation.