地佐辛对结肠镜检查时丙泊酚靶控输注麻醉EC_(50)的影响

Effect of Dezocine on EC_(50) of Propofol in Using Target Controlled Infusion for Colonoscopy

目的:研究预先注射地佐辛对结肠镜检查时患者丙泊酚血浆半数有效浓度(EC50)的影响,并观察地佐辛复合丙泊酚用于结肠镜检查麻醉的安全性。方法:82例拟进行结肠镜检查患者分成两组:对照组为丙泊酚靶控输注组(A组,n=49),干预组为地佐辛+丙泊酚靶控输注组(B组,n=33);丙泊酚初始血浆浓度设为4.5 g/mL,其后根据结肠镜检查过程中患者有无体动以0.5 g/mL为增减量进行调整,按照升降序贯试验法计算A、B组丙泊酚血浆EC50及95%可信区间,记录结肠镜检查术中各项生理指标的变化。结果:A组丙泊酚EC50为4.15 g/mL,95%可信区间为3.51~4.87 g/mL;B组丙泊酚EC50为3.32 g/mL,95%可信区间为2.91~3.65 g/mL。与A组比较,B组丙泊酚总消耗量明显较少(P<0.05),意识恢复时间明显缩短(P<0.05)。A组与B组患者肠镜检查各时间点的MAP、HR与术前(T0)比较明显下降(P<0.05),但大部分患者MAP大部分均在30%以内,A组2例需要用麻黄素纠正,A组T3时间点3例心动过缓需要使用阿托品纠正。结论:预先注射地佐辛可以明显降低结肠镜检查时丙泊酚总消耗量,且显著缩短患者意识恢复时间,地佐辛复合丙泊酚靶控输注可以安全用于结肠镜检查麻醉。

Objective To investigate the effect of dezocine pre-injection on the median effective concentration( EC50) of propofol in patients undergone colonoscopy,and evaluate the safety of dezocine combined propofol in colonoscopy. Methods Eighty-two patients undergone colonoscopy were divided into two groups( group A,target controlled infusion with propofol,n= 49; group B,given pre-injection of dezocine based on group A,n = 33). The initial concentration of propofol was 4. 5 g /mL,and then up-or down-regulated the propofol with a dose of 0. 5 g / mL every time according to the body movement of patients. The plasma EC50and 95% confidence intervals( 95% CI) of propofol were calculated with up-and-down sequential trials,and the changes of physiological index were recorded. Results The EC50of propofol in group A was 4. 15 g / mL,95% CI was 3. 51 ~ 4. 87 g / mL. The EC50of propofol in group B was 3. 32 g / mL,95% CI was 2. 91 ~ 3. 65 g / mL. Compared with group A,the consumption of propofol in group B was significantly lower and the time of recovery consciousness was significantly shorter( both P < 0. 05). The MAP and HR in all patients were lower than those before operation( T0) at all time points during colonoscopy,but the MAP were lower less than 30% in mostly patients. In group A,2 cases were given ephedrine because of hypotension,3 cases were given atropine because of bradycardia at T3. Conclusion Pre-injection of dezocine could decrease the consumption of propofol and the time of recovery consciousness,therefore dezocine combined with propofol target controlled infusion could be safely used for colonoscopy anaesthesia.