靶控输注丙泊酚-瑞芬太尼清醒镇静镇痛在结肠镜检查中的应用

Conscious sedation and ease pain with propofol and remifentanil given by target- controlled infusion for colonoscopy

目的：研究靶控输注丙泊酚-瑞芬太尼清醒镇静镇痛用于结肠镜检查的有效性、安全性和可行性。方法：60例ASA（美国麻醉医师协会）Ⅰ、Ⅱ级行结肠镜检查的患者，分为麻醉组（T组）和对照组（C组），每组30例，T组：丙泊酚叭浆靶浓度0．5-1．2μg／mL、瑞芬太尼血浆靶浓度0．5～1．0ng／mL同时输注，待患者进入Ramsay（镇静分级评分）2级开始镜检，肠镜抵达回肓部停止给药。C组：未用药。结果：Ramsay评分：T组2级96．7％，C组1级100％，（P〈0．01）。VAS（视觉模拟评分）：T组明显小于C组（P〈0．01）。T组入镜时间短于C组（P〈0．05）。检查过程中：SBP、DBP、HR、LF、HF、L／H在C组明显上升（P〈0．05，P〈0．01）；BIS在T组明显降低（P〈0．01）；血糖在C组升高（P〈0．05）。T组检查成功率、操作者和患者的满意率、患者愿意再次接受检查率均明显高于C组僻〈0．01）。结论：靶控输注（TCI）丙泊酚-瑞芬太尼用于结肠镜检查能达到良好的清醒镇静镇痛麻醉效果，有效抑制应激反应，稳定血流动力学，缩短入镜时间，提高检查的成功率、患者的耐受性和依从性，是一种安全、有效、可行的麻醉方法。

Objective： To study the validity, security and feasibility of conscious sedation and ease pain with propofol and remifentanil given by target-controlled infusion （ TCI ） on colonoscopy. Methods： Sixty ASA （American society of anesthesiologists ） Ⅰ,Ⅱ patients undergoing colonoscopy were divided into two group of 30 patients ： anesthesia group （ group T ） and control group （ group C ）. The plasma concentration of propofol was set at 0.5 -1.2μg /mL and remifentanil at 0.5 -1.0 ng/ mL in group T , colonoscopy was undergone when Ramsay score was 2 and TCI was stopped when colonoscope reached ileocecal valve .Colonoscopy was undergone without anesthesia in group C. Results： Ramsay score ： The percentage was 96.7% of grade 2 in group T and 100% for grade lin group C （ P 〈 0.01 ） .VAS （ visual analogue scale ） in group T decreased significantly than that in group C （ P 〈 0.01 ）.The manipulation duration of group T was shorter than that of group C （ P 〈 0.05）. During colonoscopic procedure： SBP, DBP, HR, LF, HF , L/H raised significantly in group C （ P 〈 0.05,P〈 0.01）;BIS reduced significantly in group T （ P 〈 0.01 ）;blood sugar rised in group C （ P 〈 0.05 ）. The success rate of examination , the percentage of satisfaction on both patients and physician, the percentage of willing examination again on patients in group T were higher as compared with group C. Conclusion： TCI propofol-remifentanil for coh,noscopy can provides sufficient analgesia of conscious sedation and ease pain, satisfactory hemodynamie stability and inhibit the occurrence of stress reaction substantially, shorten operation duration, advances the success ratio of examination , patients＇ acceptance and compliance , in short , it is a safe ,efficient and feasible anesthesia .