瑞芬太尼-丙泊酚静脉麻醉用于无痛胃镜检查术的疗效观察

The anesthetic effect of rimifentani and propofol used in painless gastroscopy

目的为探讨安全、有效无痛胃镜检查术的药物选择和剂量,选用最新的μ阿片受体激动药瑞芬太尼和短效静脉麻醉药丙泊酚组合,采用对照的方法,观察其临床疗效。方法200例接受无痛胃镜检查术的患者,静脉麻醉药按公斤体重用药配制,分成4组,Ⅰ组丙泊酚(即得普利麻,下同)2mg/kgiv;Ⅱ组芬太尼1μg/kg+丙泊酚2mg/kgiv;Ⅲ组瑞芬太尼0·5μg/kg+丙泊酚1·5mg/kgiv;Ⅳ组瑞芬太尼0·75μg/kg+丙泊酚1mg/kgiv。观察指标:起效时间,麻醉深度,术中HR、R和SpO2的变化,有无呛咳、喉痉挛等副作用,术毕清醒时间和离院时间,以及术后有无恶心、呕吐等并发症。结果Ⅳ组与其他各组比较,起效时间,清醒时间,离院时间,麻醉深度,术中呼吸抑制等指标均有显著差异(P<0·01)。结论选用瑞芬太尼0·75μg/kg与丙泊酚1mg/kg复合的静脉麻醉配方用于胃镜检查起效快,清醒快,麻醉深度合适,术中、术后副作用少,适用于胃镜检查,只要注意预防药物的副作用,是一种安全、有效、可控性强的麻醉方法。

Objective To find out an optimal anesthesia and the dosage used in painless gastroscopy, and to evaluate its efficiency. Methods 200 patients undergoing painless gastroscopy were divided into 4 groups randomly. 2μg/kg iv of propofol was used in group Ⅰ, fentani 1μg/kg＋ propofol 2μg/kg in group Ⅱ. rimifentani 0.5μg/kg ＋ propofol 1.5μg/kg in group Ⅲ, and rimifentani 0.75μg/kg ＋ propofol 0.75μg/kg in group Ⅳ. Observed objects induced starting time and depth of anaesthesia, HR, R and SpO2 during operation, side effects such as cough reflex and larynx spasm, time of regaining consciousness, postoperative side effects such as nausea and vomiting. Result Significant differences （P〈0.01） were found between group Ⅳ and the other 3 groups in starting time and depth of anaesthesia, side effects, time of regaining consciousness and suppression of respiration during operation. Conclusion Combined rimifentani 0.75μg/kg ＋ propofol 0.75μg/kg are optimal anestheties in painless gastroscopy if side effects are prevented.